OBJECTIVES: Results of the IMPACT trial have shown the clinical benefit of single inhaler, once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100μg/62.5μg/25μg compared to UMEC/VI (62.5/25μg) in patients with moderate/severe COPD, from a Canadian public health care perspective.

METHODS: The lifetime horizon analysis used a validated COPD disease progression model (Briggs et al., Med Decis Making 37;4 2017) populated with baseline inputs and treatment effects from the IMPACT trial (NCT02164513). Costs and health outcomes after year one were discounted at 1.5%. Sensitivity analyses explored the robustness of results to varying parameter values and assumptions. All analyses were probabilistic (5000 iterations) and outputs included exacerbation rates, costs (2018 CAD), life-years (LYs,) quality-adjusted life years (QALYs) gained and incremental cost effectiveness ratio (ICER) per QALY.

RESULTS: For FF/UMEC/VI and UMEC/VI, per patient over their lifetime, the predicted cumulative number of exacerbations was 10.16 and 11.12, accumulated LYs (undiscounted) were 9.07 and 8.96, accumulated QALYs were 5.25 and 5.13,and total accumulated costs were $64,678 and $62,877 respectively . Patients who received FF/UMEC/VI gained an additional 0.12 LYs (95% CI 0.05 to 0.19), 0.12 QALYs (95% CI, 0.08 - 0.17) with an additional cost of $1,801 (95% CI $1,225- $2,316). The resulting ICER was $14,864 (95% CI, $11,151 - $20,850) per QALY gained. In all sensitivity analyses, FF/UMEC/VI remained cost-effective, including at shorter time horizons of 5 and 10 years.

CONCLUSIONS: Treatment with FF/UMEC/VI was predicted to improve health outcomes and be a cost-effective option for treatment of moderate/severe COPD compared with UMEC/VI, in Canada.