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. 2025 May 23;15(1):42.
doi: 10.1186/s13561-025-00640-9.

A cost-effectiveness analysis comparing single-inhaler extrafine beclomethasone/formoterol/glycopyrronium bromide against other SITTs in adult patients with uncontrolled asthma in England

Ioanna Vlachaki  1 , Simon Donhauser  2 , Alessandra Madoni  2 , Marielle van der Deijl  2 , Yuvraj Sharma  3 , Dimitrios Tzelis  4 , Ines Guerra  3
Affiliations

A cost-effectiveness analysis comparing single-inhaler extrafine beclomethasone/formoterol/glycopyrronium bromide against other SITTs in adult patients with uncontrolled asthma in England

Ioanna Vlachaki et al. Health Econ Rev. .

Abstract

Background: In patients with asthma uncontrolled by a medium or high-strength (MS/HS) inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA), according to Global Initiative for Asthma (GINA) guidelines, a maintenance therapy option is the addition of a long-acting muscarinic antagonist (LAMA) via single-inhaler triple therapy (SITT). Evidence has previously been published on the cost-effectiveness of a SITT extra fine formulation of beclomethasone, formoterol and glycopyrronium bromide (BDP/FOR/GLY) vs. dual ICS/LABA combination, using data from two 52-week clinical trials (TRIMARAN and TRIGGER). However, there is limited evidence on the comparative cost-effectiveness of SITTs. The current analysis evaluated the cost-effectiveness of BDP/FOR/GLY versus other SITTs, in the UK setting.

Methods: Markov cohort state-transition model was developed to investigate the cost-effectiveness of BDP/FOR/GLY Medium Strength (MS) vs. fluticasone, umeclidinium, and vilanterol (FF/UMEC/VI) MS and, BDP/FOR/GLY High Strength vs. FF/UMEC/VI HS and vs. indacaterol acetate, glycopyrronium bromide, and mometasone (IND/GLY/MF) HS. A network meta-analysis was performed to estimate comparative efficacy of BDP/FOR/GLY against other SITTs. The model analyzed cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and was developed from the perspective of England National Health Service (NHS) and Prescribed Specialized Services expenditure (2022 costs). Uncertainty of the inputs was estimated using one-way and probabilistic sensitivity analyses.

Results: BDP/FOR/GLY MS was projected to be a dominant treatment alternative against FF/UMEC/VI MS (£5,121 less costly, gained 0.065 additional QALYs). Similarly, BDP/FOR/GLY HS was a dominant treatment alternative against FF/UMEC/VI HS (£143, 0.003 additional QALYs) and IND/GLY/MF HS (£692 less costly, gained 0.023 additional QALYs). BDP/FOR/GLY MS and HS had 77.1%, 51.3%, and 61.2% likelihoods to be cost-effective vs. FF/UMEC/VI MS, FF/UMEC/VI HS, and IND/GLY/MF HS at the defined willingness-to-pay (WTP) threshold of £20,000 per QALY gained, respectively.

Conclusions: BDP/FOR/GLY MS and HS were a dominant treatment alternative compared with FF/UMEC/VI, both MS and HS, and IND/GLY/MF HS in patients with asthma uncontrolled by ICS/LABA.

Keywords: Asthma; Cost-effectiveness; England; Exacerbations; Network meta-analysis; Single-inhaler triple therapy.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Previous presentations: The paper is original, nor all neither any of its parts have been reproduced in other publications.

Figures

Fig. 1
Fig. 1
Schematic of states in the Markov transition model
Fig. 2
Fig. 2
Tornado diagrams (NBM). a. BDP/FOR/GLY MS vs. FF/UMEC/VI MS. b. BDP/FOR/GLY HS vs. FF/UMEC/VI HS. c. BDP/FOR/GLY HS vs. IND/GLY/MF HS. HS: High strength; MS: Medium strength; NBM: Net monetary benefit. BDP/FOR/GLY: Beclomethasone, Formoterol, and Glycopyrronium bromide; FF/UMEC/VI: Fluticasone, Umeclidinium, and Vilanterol; IND/GLY/MF; Indacaterol acetate, Glycopyrronium bromide, and Mometasone; RR: Rate ratio
Fig. 3
Fig. 3
Cost-effectiveness plane. a) BDP/FOR/GLY MS vs. FF/UMEC/VI MS. b) BDP/FOR/GLY HS vs. FF/UMEC/VI HS and IND/GLY/MF HS. HS: High strength; MS: Medium strength; PSA: Probabilistic sensitivity analysis QALY: quality-adjusted life year; WTP: Willingness-to-pay. BDP/FOR/GLY: Beclomethasone, Formoterol, and Glycopyrronium bromide; FF/UMEC/VI: Fluticasone, Umeclidinium, and Vilanterol; IND/GLY/MF; Indacaterol acetate, Glycopyrronium bromide, and Mometasone
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