OBJECTIVES: Current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend inhaled corticosteroids (ICS) to treat stable chronic obstructive pulmonary disease (COPD) patients with moderate-severe manifestations that cannot be solved by the use of long-acting muscarinic antagonist (LAMA), long-acting beta2-agonist (LABA) or a combination of those. Despite the guidelines’ recommend to avoid long-term therapies with ICS, in clinical practice its use is known to be extensive. The objective of the present work is to explore the clinical and economic consequences of switching from ICS-containing regimens (LABA+ICS, LABA+LAMA+ICS) to LABA+LAMA regimens in the maintenance therapy of GOLD II-IV patients in Spain.

METHODS: The consequences associated to switches among different treatment alternatives for patients with stable moderate-severe COPD (GOLD classification II-IV) were calculated using a 5-year budget impact model. Main therapies considered were LAMA, LABA+LAMA, LABA+ICS and triple therapy (LABA+LAMA+ICS). Resource use changes were associated to different risk profiles of these maintenance COPD treatments for COPD exacerbations, pneumonia and diabetes events. Data on demographics, frequencies and related costs were obtained from the literature and national databases. Spanish costs were used and updated to 2018. Spanish National Health System (NHS) perspective was considered including direct health costs.

RESULTS: Switching COPD patients not requiring ICS to a non-ICS regimen resulted in less COPD exacerbations, pneumonia and diabetes events (expected annual reductions between 2% and 9%). Moreover, annual cost reductions between 1% and 10% are expected derived from a decrease in COPD exacerbation, treatment, diabetes and pneumonia cost categories.

CONCLUSIONS: