OBJECTIVES: As acknowledged by international GOLD and Canadian treatment recommendations, inhaled triple therapy may be appropriate for some patients with chronic obstructive pulmonary disease (COPD). The cost-effectiveness of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) vs. FF/VI was thus assessed from a Quebec societal perspective, leveraging data from the IMPACT trial (NCT02164513).

METHODS: A validated linked risk equation, COPD disease progression, model (Briggs 2017 Med Decis Making 37:4) was populated with baseline characteristics, efficacy and medication use from IMPACT. Quebec healthcare resource and societal and drug costs were applied, with future costs and health outcomes discounted at 1.5% annually. The analysis was probabilistic, with a lifetime horizon. Outputs included exacerbation rates, costs (2017 CAD), life-years (LYs), quality-adjusted life years (QALYs) gained and incremental cost effectiveness ratio (ICER) per QALY. Sensitivity analyses explored the robustness of results by varying parameter values and assumptions.

RESULTS: Compared with FF/VI, FF/UMEC/VI resulted in fewer moderate and severe exacerbations (10.52 and 3.38 versus 11.12 and 3.48), translating to fewer total per patient per year exacerbations (1.53 versus 1.62). Overall mean (95% CI) incremental costs were $2,489 ($1,861, $3,212) for FF/UMEC/VI compared with FF/VI but total indirect non-drug costs were lower ($4,428 versus $4,608). Incremental LYs (undiscounted, 95% CI) and QALYs were 0.14 (0.07, 0.21) and 0.13 (0.09, 0.18), resulted in an ICER of $18,887 ($14,625, $25,587) per QALY. The probability of FF/UMEC/VI being cost-effective compared with FF/VI was 100%, at a willingness-to-pay WTP) threshold of $50,000 per QALY. Across all scenarios considered the ICER ranged from $14,281 to $23,798, remaining below the WTP threshold. Results were most sensitive to time horizon, efficacy of treatment post-discontinuation and changing FF/VI cost.

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