Economic evaluation of the impact of exacerbation frequency in COPD patients treated with single-inhaler triple therapy in Spain: The IMPACT trial

Introduction: The IMPACT study (NTC02164513) showed the clinical benefit of single-inhaler triple therapy (fluticasone furoate [FF]/umeclidinium [UMEC]/vilanterol [VI]) vs dual therapy with FF/VI and UMEC/VI in symptomatic COPD patients at risk of exacerbations. This was also demonstrated in subgroups with either ≥2 moderate or ≥1 severe exacerbation in the prior year (SG1), or Objective: Assess the cost-effectiveness of FF/UMEC/VI vs FF/VI and UMEC/VI by exacerbation history from a Spanish national healthcare system perspective. Methods: A published model of linked risk equations to predict disease progression, costs, and health outcomes was populated with baseline characteristics and treatment efficacy for SG1 and SG2 from the IMPACT study. Direct costs (€2019) and utilities were based on Spanish public sources and literature. A 3% discount rate for costs and treatment effects was used. Outputs included costs, quality-adjusted life years (QALYs) and incremental cost effectiveness ratios (ICER) over 3 years. Results: In SG1, patients receiving FF/UMEC/VI were predicted to gain 0.059 QALYs with an incremental cost of €414 vs FF/VI (ICER=€7,017/QALY) and 0.059 QALYs gain with cost savings of €675 vs UMEC/VI (ICER=Dominant). In SG2, FF/UMEC/VI had a 0.059 QALY gain an incremental cost of €308 vs FF/VI (ICER=€5,259/QALY) and 0.032 QALYs and €252 vs UMEC/VI (ICER=€7,817/QALY). Conclusions: FF/UMEC/VI is a cost-effective treatment option vs. dual therapies for symptomatic COPD at risk of exacerbations in Spain, irrespective of exacerbation history. Funding: GSK HO-17-17596