OBJECTIVES: The updated 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Strategy positions a combination of a LAMA (long-acting muscarinic antagonist) and a LABA (long-acting beta2-agonist), as a mainstay treatment for the majority of symptomatic Chronic Obstructive Pulmonary Disease (COPD) patients. However, a significant dissociation is still observed between guidelines and clinicians’ practice. An inconsistent implementation of GOLD recommendations could lead to many symptomatic COPD patients being inappropriately prescribed with regimens containing inhaled corticosteroid (ICS).

The aim of this study is to quantify the economic impact on the Portuguese National Health System (NHS) of switches between different maintenance therapy options in COPD patients.

METHODS: The model estimates the clinical and economic outcomes of the COPD population from 2018 to 2021. A projection was made to calculate the economic burden associated with scenarios comprising different shares of ICS-containing therapies switching to LAMA-LABA. Clinical outcomes were based on differences in risk profile of maintenance COPD therapies related with exacerbations, Lower Respiratory Tract Infection (LRTI) / pneumonia and diabetes events. Data was based on Portuguese data and published literature.

RESULTS: Switching all LABA-ICS and LAMA-LABA-ICS patients (ICS patients without ICS recommendation according to The 2017 GOLD guidelines) to LAMA-LABA could avoid 43,267 COPD exacerbations, 10,754 LRTI / pneumonias and 4,223 diabetes complications in Portugal from 2018 to 2021. This could represent total savings of €25 Million for the Portuguese NHS.

CONCLUSIONS: The 2017 GOLD guidelines support first-line use of LAMA-LABA for the majority of symptomatic COPD patients. This model demonstrates that switching from ICS-containing regimens to LAMA-LABA could not only provide better clinical outcomes but also be cost-saving to the Portuguese NHS due to less health care resource use.