Cost-Effectiveness of Once-Daily, Single-Inhaler Indacaterol Acetate/ Glycopyrronium Bromide/ Mometasone Furoate in Patients with Uncontrolled Moderate-to-Severe Asthma in Canada

Abstract

Purpose We evaluated the cost-effectiveness of high-dose indacaterol acetate (IND)/glycopyrronium bromide (GLY)/mometasone furoate (MF) (150/50/160 μg, once daily) compared with high-dose salmeterol/fluticasone (SAL/FLU; 50/500 µg, twice daily)+tiotropium (TIO; 5 µg, once daily) (SAL/FLU+TIO) and with high-dose SAL/FLU (50/500 µg, twice daily) for the treatment of inadequately controlled moderate-to-severe asthma. Patients and Methods A Markov model estimated the incremental cost-effectiveness ratio of treatment with high-dose IND/GLY/MF compared with SAL/FLU+TIO and high-dose IND/GLY/MF compared with SAL/FLU. The model included three health states (day-to-day symptoms without exacerbations, day-to-day symptoms with exacerbations, and death) with a 4-week cycle length. A lifetime time horizon was used. Exacerbation rates and utility values were derived from ARGON and IRIDIUM clinical trials. Canadian dollars (CAD$, 2020) were applied. Results IND/GLY/MF was the less costly and more effective treatment strategy compared with SAL/FLU+TIO and SAL/FLU in the base-case analyses. IND/GLY/MF had lower costs (CAD $33,501 versus CAD $50,907) and higher quality-adjusted life-years (QALYs) (18.37 versus 18.06 QALYs) compared with SAL/FLU+TIO. Compared with SAL/FLU, IND/GLY/MF had lower costs (CAD $33,408 versus CAD $36,577) and higher QALYs (19.33 versus 19.04 QALYs). IND/GLY/MF was the most cost-effective option in all scenarios tested. Conclusion IND/GLY/MF was cost-effective at a willingness-to-pay threshold of CAD $50,000/QALY in patients with uncontrolled, moderate-to-severe asthma versus SAL/FLU+TIO and SAL/FLU in the base case and all scenarios tested.

Optimizing asthma management: Role of long-acting muscarinic antagonists

“…In a Canadian study, singleinhaler triple therapy of IND/GLY/MF had lower costs (Canadian $33,501 vs $50,907) and higher QALYs (18.37 vs 18.06) compared with salmeterol, and fluticasone plus tiotropium in Improved morning and evening predose PEF 43 Noninferior to LABA in maintaining mean weekly predose PEF and evening predose PEF 52 Improved in-clinic trough PEFR 47 Improved morning 37,38,40 and evening PEF 37,40 FEV patients with uncontrolled, moderate to severe asthma. 89 In Italian adult patients with asthma who had 1 or more asthma exacerbation in the previous year and whose asthma was not well controlled with a high-dose ICS and LABA, high-dose IND/ GLY/MF as maintenance treatment was found to be costeffective (incremental cost-utility ratio 5 V14,088/QALY). 90…”