Cost Effectiveness of the Long-Acting β2-Adrenergic Agonist (LABA)/Long-Acting Muscarinic Antagonist Dual Bronchodilator Indacaterol/Glycopyrronium Versus the LABA/Inhaled Corticosteroid Combination Salmeterol/Fluticasone in Patients with Chronic Obstructive Pulmonary Disease: Analyses Conducted for Canada, France, Italy, and Portugal

M. Reza Maleki-Yazdi (), Mathieu Molimard, Dorothy L. Keininger, Jean-Bernard Gruenberger, Joao Carrasco, Claudia Pitotti, Elsa Sauvage, Sara Chehab and David Price
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M. Reza Maleki-Yazdi: Women’s College Hospital, University of Toronto
Mathieu Molimard: CHU and University of Bordeaux
Dorothy L. Keininger: Primary Care Franchise, Novartis Pharma AG, Postfach
Jean-Bernard Gruenberger: Primary Care Franchise, Novartis Pharma AG, Postfach
Joao Carrasco: Health Economics and Outcomes Research, Novartis Farma–Produtos Farmacêuticos SA.
Claudia Pitotti: Health Economics, Novartis Farma S.p.A.
Elsa Sauvage: Strategy Pricing, Novartis Pharma S.A.S.
Sara Chehab: Health Policy and Patient Access, Novartis Pharmaceuticals Canada Inc.
David Price: University of Aberdeen

Applied Health Economics and Health Policy, 2016, vol. 14, issue 5, No 8, 579-594

Abstract: Abstract Objective The objective of this study was to assess the cost effectiveness of the dual bronchodilator indacaterol/glycopyrronium (IND/GLY) compared with salmeterol/fluticasone combination (SFC) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) who had a history of one or no exacerbations in the previous year, in Canada, France, Italy, and Portugal. Methods A patient-level simulation was developed to compare the costs and outcomes of IND/GLY versus SFC based on data from the LANTERN trial (NCT01709903). Monte-Carlo simulation methods were employed to follow individual patients over various time horizons. Population and efficacy inputs were derived from the LANTERN trial. Considering the payers’ perspective, only direct costs were included. Costs and health outcomes were discounted annually at 3.0 % for all countries. Unit costs were taken from publically available sources with all costs converted to euros (€). The cost base year was 2015. Deterministic and probabilistic sensitivity analyses were undertaken to test the robustness of the model results. Results IND/GLY was found to be the dominant (more effective and less costly) treatment option compared with SFC in all four countries. The use of IND/GLY was associated with mean total cost savings per patient over a lifetime of €6202, €1974, €1611, and €220 in Canada, France, Italy, and Portugal, respectively. Sensitivity analysis showed that exacerbation rates had the largest impact on incremental costs and quality-adjusted life-years (QALYs). The probability of IND/GLY being cost effective was estimated to be >95 % for thresholds above €5000/QALY. Conclusion In patients with moderate to severe COPD, IND/GLY is likely to be a cost-effective treatment alternative compared with SFC.

Date: 2016
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DOI: 10.1007/s40258-016-0256-z

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