Cost-effectiveness of indacaterol/glycopyrronium in comparison with salmeterol/fluticasone combination for patients with moderate-to-severe chronic obstructive pulmonary disease: a LANTERN population analysis from Singapore

Abstract

IND/GLY was estimated to be highly cost-effective compared to SFC in patients with moderate-to-severe COPD who are not at high risk of exacerbations in the Singapore healthcare setting.

<p>Modelling the Cost-Effectiveness of Indacaterol/Glycopyrronium versus Salmeterol/Fluticasone Using a Novel Markov Exacerbation-Based Approach</p>

“…24 In addition, given the highly controlled nature of clinical trials, the present analysis may not take into account realworld factors that influence outcomes in COPD, such as inhaler technique or treatment adherence. 46,47 These are common limitations of cost-effectiveness analyses in COPD that use clinical trial data, 17,18,20,47 and more generally of the clinical trials themselves. 46 Finally, after the availability of data from clinical trials involving fixed-dose combinations of LABA/LAMA/ICS, 48,49 future costeffective studies of LABA/LAMA may consider these as comparative pharmacologic intervention.…”

“…To address this limitation, patient-level (or micro) simulation models have been developed, which consider a much broader range of clinical events and complications, such as exacerbations, symptom worsening, pneumonia and changes in health-related quality of life (HRQoL). [16][17][18][19][20] Such models include a recent patient-level simulation model that included 14 patient characterstics, seven intermediate outcomes (eg lung function, exacerbations, and pnemonias) and three final outcomes (mortality, qualityadjusted life years [QALYs] and costs), which allowed for evaluation of the effect of treatment for various subgroups of COPD patients. 21 Indacaterol/glycopyrronium (IND/GLY) was the first LABA/LAMA combination to be approved for the treatment of COPD and consequently, its cost-effectiveness has been studied extensively, [16][17][18][19]22,23 including via microsimulation modelling.…”

“…[16][17][18][19][20] Such models include a recent patient-level simulation model that included 14 patient characterstics, seven intermediate outcomes (eg lung function, exacerbations, and pnemonias) and three final outcomes (mortality, qualityadjusted life years [QALYs] and costs), which allowed for evaluation of the effect of treatment for various subgroups of COPD patients. 21 Indacaterol/glycopyrronium (IND/GLY) was the first LABA/LAMA combination to be approved for the treatment of COPD and consequently, its cost-effectiveness has been studied extensively, [16][17][18][19]22,23 including via microsimulation modelling. 18,20 In the microsimulation model, 20 IND/GLY was shown to be cost-effective compared with the LABA/ inhaled corticosteroid (ICS) combination salmeterol/fluticasone (SFC) in patients at risk of exacerbations.…”

Economic evaluations of chronic obstructive pulmonary disease pharmacotherapy: how well are the real-world issues of medication adherence, comorbidities and adverse drug-reactions addressed?

“…Twenty-five out of the 28 studies (89%) were economic evaluations or BIAs conducted in a single country/region: Canada [18], France [19], USA [20,27], Czech Republic [23], Spain [22,34,[37][38][39], UK [21,24,28,35,43], Taiwan [25], Sweden [26], the Netherlands [15,29], Scotland [30], Italy [32,40,41], Singapore [36] and Russia [44]. Three studies included multiple countries [31,33,42].…”

“…Twenty-two studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]43,44] explored COPD treatment cost-effectiveness (79%), of which two [29,44] performed a BIA as well. Six studies [15,[38][39][40][41][42] conducted BIA only.…”