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. The use of inhaled corticosteroid (ICS) in combination with LABA is reserved for GOLD C patients as an alternative to the combination of LABA and LAMA. The triple therapy (LAMA-LABA-ICS) is reserved for GOLD D patients on LAMA-LABA therapy with further exacerbations. The aim of this study is to quantify the future burden of disease and the associated cost of COPD under current and different market share scenarios in Greece.

METHODS: An annual, multi-cohort, health-state-transition model assessed the clinical and economic outcomes of the COPD population from 2017 to 2021. The model tracked the progression of the 2017 prevalent COPD population and added a new cohort of incident patients. Health outcomes included the number of COPD exacerbations and Lower Respiratory Tract Infection (LRTI) / pneumonia events. Epidemiology and cost data were derived from published literature. The model is based on four scenarios with different shares of ICS-containing therapies switching to LAMA-LABA.

RESULTS: In the base case (LAMA: 10% share, LAMA-LABA: 15%, LABA-ICS: 35%, LAMA-LABA-ICS: 40%) the total cost of COPD is estimated to be about €330M and 234,000 exacerbations are expected during the study period. In scenario B (LABA-ICS: 15%), C (LABA-ICS: 20% and LAMA-LABA-ICS: 30%) and D (LABA-ICS: 2% and LAMA-LABA-ICS: 5%) €97k savings and 12,200 fewer exacerbations, €5,1M savings and 8,700 fewer exacerbations, and €17M and 18,500 fewer exacerbations are expected vs. base case, respectively.

CONCLUSIONS: It seems worthwhile to adjust the market share of COPD in favor to LAMA/LABA, especially in resource-stricken countries, such as Greece, since it constitutes a critical cost saving strategy.