Cost-effectiveness of umeclidinium/vilanterol combination therapy compared to tiotropium monotherapy among symptomatic patients with chronic obstructive pulmonary disease in the UK

Abstract

Background: The cost-effectiveness of umeclidinium bromide-vilanterol (UMEC/VI) versus tiotropium monotherapy in the UK was assessed using a UMEC/VI treatment-specific economic model based on a chronic obstructive pulmonary disease (COPD) disease-progression model.

Methods: The model was implemented as a linked-equation model to estimate COPD progression and associated health service costs, and its impact on quality-adjusted life years (QALYs) and survival. Statistical risk equations for clinical endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. For the selected timeframe (1-40 years) and probabilistic analysis, model outputs included disaggregated costs, total costs, exacerbations, life-years and QALYs gained, and incremental cost-effectiveness ratios (ICERs).

Results: Random-effects meta-analysis of tiotropium comparator trials estimated treatment effect of UMEC/VI as 92.17 mL (95 % confidence interval: 61.52, 122.82) in forced expiratory volume in 1 s. With this benefit, UMEC/VI resulted in an estimated annual exacerbation reduction of 0.04 exacerbations/patient and 0.36 life years gained compared to tiotropium over patient lifetime. With an additional 0.18 QALYs/patient and an additional lifetime cost of £372/patient at price parity, the incremental cost effectiveness ratio (ICER) of UMEC/VI compared to tiotropium was £2088/QALY. This ICER increased to £17,541/QALY when price of UMEC/VI was increased to that of indacaterol plus tiotropium in separate inhalers. The ICER improved when model duration was reduced from patient lifetime to 1 or 5 years, or when treatment effect was assumed to last for 12 months following treatment initiation.

Conclusion: UMEC/VI can be considered a cost-effective alternative to tiotropium at a certain price.

Keywords: Chronic obstructive pulmonary disease; Cost-effectiveness; Tiotropium; Umeclidinium/vilanterol.

Fig. 1

a Final conceptual model of COPD. b Linked-equations disease progression model for COPD. 6MWT 6-min walk test, COPD chronic obstructive pulmonary disease, EQ-5D EuroQol 5 dimension, FEV1 forced expiratory volume in 1 s, FEV1%p forced expiratory volume in 1 s percent predicted, HRQoL health-related quality of life, QALY quality-adjusted life year, SGRQ St. George’s Respiratory Questionnaire. a Adopted from Tabberer et al. [15]. b Adapted from Briggs et al. [14]. a Figure represents association between baseline covariates, intermediate outcomes (FEV1, symptoms, exacerbations and 6MWT) and final outcomes (mortality, HRQoL and costs). Arrows represent direction of effect e.g. baseline covariates affect intermediate outcomes. b Figure represents schema of linked equations model. Baseline covariates at t = 0 predict intermediate and final outcomes at t = 1 (model cycle = 1). These then become baseline covariates t = 1 to predict intermediate and final outcomes at t = 2 (model cycle = 2)

Fig. 2

a Random-effects meta-analysis of tiotropium comparator trials. b Probabilistic sensitivity analysis: net benefit acceptability curves for UMEC/VI compared with tiotropium. CI confidence interval, ES effect size, IND indacaterol, TIO tiotropium, UMEC/VI umeclidinium bromide/vilanterol. DB2113374 and DB2113360 [11]; ZEP117115 [12]. a Effect size (ES) represents increment in FEV1 (ml) of UMEC/VI compared to tiotropium. b Each line on the graph represents probability of acceptance of UMEC/VI compared to tiotropium under a particular scenario at multiple thresholds of willingness to pay