OBJECTIVES: With a variety of chronic obstructive pulmonary disease (COPD) treatments available, there is a need to understand the cost-effectiveness of new single inhaler triple therapy. The cost-effectiveness of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) vs. UMEC/VI was assessed from a Quebec societal perspective, incorporating data from IMPACT (NCT02164513).

METHODS: Baseline characteristics, efficacy, and medication use obtained from IMPACT were populated into a validated linked risk equation, COPD disease progression, model (Briggs 2017 Med Decis Making 37:4). Quebec healthcare, societal, and drug costs were used and future costs and health outcomes were discounted at 1.5% annually. As per new Institut national d'excellence en santé et en services sociaux guidelines the analysis was conducted probabilistically, over 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. Uncertainty around base estimates was explored by varying parameter values and assumptions.

RESULTS: Compared with UMEC/VI, FF/UMEC/VI treatment resulted in fewer moderate and severe exacerbations (10.16 and 3.13 versus 11.12 and 3.48); translating to fewer total per patient per year exacerbations (1.46 versus 1.63). Overall mean (95% CI) incremental costs were $2,082 ($1,462, $2,674) for FF/UMEC/VI compared with UMEC/VI, but indirect non-drug costs were lower ($4,270 versus $4,625). Incremental LYs (undiscounted) and QALYs of 0.12 (0.05, 0.18) and 0.12 (0.07, 0.17), resulted in an ICER of $17,222 ($12,968, $24,358) per QALY. Scenario analyses showed an ICER range from $9,278 to $25,998. At a willingness-to-pay (WTP) threshold of $50,000/QALY, the probability of FF/UMEC/VI being cost-effective compared with UMEC/VI was 100% for the base case and all scenario analyses. When run deterministically FF/UMEC/VI remained below the WTP threshold (ICER of $17,205).

CONCLUSIONS: FF/UMEC/VI was found to be a cost-effective treatment in patients with symptomatic COPD and a history of exacerbations despite use of maintenance therapy with UMEC/VI in Quebec.