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. 2024 Sep:231:107694.
doi: 10.1016/j.rmed.2024.107694. Epub 2024 Jun 4.

The long-term clinical and economic benefits of treating advanced COPD patients with single-inhaler triple therapy in Quebec, Canada - The IMPACT trial

Nancy A Risebrough  1 , Sara Mursleen  2 , Kerigo Ndirangu  3 , Dhvani Shah  4 , Alan Martin  5 , Melanie Schroeder  6 , Afisi S Ismaila  7
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Free article

The long-term clinical and economic benefits of treating advanced COPD patients with single-inhaler triple therapy in Quebec, Canada - The IMPACT trial

Nancy A Risebrough et al. Respir Med. 2024 Sep.
Free article

Abstract

Background: This cost-utility analysis assessed the long-term clinical and economic benefits of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy vs FF/VI or UMEC/VI from a Quebec societal perspective in patients with chronic obstructive pulmonary disease (COPD) with ≥1 moderate/severe exacerbation in the previous year.

Methods: The validated GALAXY disease progression model was utilized, with parameters set to baseline and efficacy data from IMPACT. Treatment costs (2017 Canadian dollars [C$]) were estimated using Quebec-specific unit costs. Costs and health outcomes were discounted at 1.5 %/year. A willingness-to-pay threshold of C$50,000/quality-adjusted life year (QALY) was considered cost-effective. Outcomes modeled were exacerbation rates, QALYs, life years (LYs), costs and incremental cost-effectiveness ratios (ICERs). Subgroup analyses were performed according to prior treatment, exacerbation history in the previous year, and baseline lung function.

Results: Over a lifetime horizon, FF/UMEC/VI resulted in more QALYs and LYs gained, at a small incremental cost compared with FF/VI and UMEC/VI. From a societal perspective, the estimated ICER for the base case was C$18,152/QALY vs FF/VI, and C$15,847/QALY vs UMEC/VI. For the subgroup analyses (FF/UMEC/VI compared with FF/VI and UMEC/VI), ICERs ranged from: C$17,412-25,664/QALY and C$16,493-18,663/QALY (prior treatment); C$15,247-19,924/QALY and C$15,444-28,859/QALY (exacerbation history); C$14,025-34,154/QALY and C$16,083-17,509/QALY (baseline lung function).

Interpretation: FF/UMEC/VI was predicted to improve outcomes and be cost-effective vs both comparators in the base case and all subgroup analyses, and based on this analysis would be an appropriate investment of health service funds in Quebec.

Clinical trial registration number: IMPACT trial NCT02164513.

Keywords: COPD; Cost-effectiveness; Cost-utility analysis; Quality of life; Societal perspective; Triple therapy.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.S. Ismaila, M. Schroeder, A. Martin, S. Mursleen: are/were employees of, and hold shares in, GSK. A.S. Ismaila: unpaid, part-time professor at McMaster University, Canada. N.A. Risebrough, D. Shah, K. Ndirangu: employees of ICON plc, which received funding from GSK to conduct this study, but were not themselves paid for development of this manuscript.

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