Cost-effectiveness of single-inhaler extrafine beclometasone dipropionate/formoterol fumarate/glycopyrronium in patients with uncontrolled asthma in England

Respir Med. 2022 Sep:201:106934. doi: 10.1016/j.rmed.2022.106934. Epub 2022 Jul 19.

Abstract

Background: In patients with asthma that is uncontrolled by a medium- or high-dose inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA), a maintenance therapy option is the addition of a long-acting muscarinic agonist, either via multiple inhalers, or single-inhaler triple therapy (SITT). One SITT is the extrafine formulation of beclometasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). We used data from two 52-week clinical trials (TRIMARAN and TRIGGER), both conducted in adults with asthma uncontrolled by ICS/LABA, to investigate the cost-effectiveness of BDP/FF/G.

Methods: A Markov cohort state transition model (focusing on exacerbations) was used to investigate the cost-effectiveness of medium- or high-dose BDP/FF/G vs medium- or high-dose BDP/FF, and high-dose BDP/FF/G vs high-dose BDP/FF + tiotropium. The model analysed cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER), and was developed from the England National Health Service perspective (2020 costs). Uncertainty of the inputs was estimated using one-way and probabilistic sensitivity analyses.

Results: Both medium- and high-dose BDP/FF/G were cost-effective vs BDP/FF, with ICERs of £12,224 and £15,587 per QALY gained. High-dose BDP/FF/G was dominant vs BDP/FF + tiotropium, as it was both cheaper and gained QALYs. Sensitivity analyses were consistent with the base model: medium- and high-dose BDP/FF/G had 94.3% and 88.3% likelihoods to be cost-effective vs BDP/FF; high-dose BDP/FF/G had 100% likelihood to be a dominant strategy vs BDP/FF + tiotropium.

Conclusions: Both medium- and high-dose BDP/FF/G were cost-effective vs medium- and high-dose BDP/FF in adults with asthma that was uncontrolled by ICS/LABA. In addition, high-dose BDP/FF/G was a dominating strategy to high-dose BDP/FF + tiotropium.

Clinicaltrials: GOV: NCT02676076 and NCT02676089.

Keywords: Asthma; Cost-effectiveness; Exacerbations; Triple therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Asthma* / drug therapy
  • Beclomethasone*
  • Clinical Trials as Topic
  • Cost-Benefit Analysis
  • Drug Combinations
  • Formoterol Fumarate
  • Fumarates / therapeutic use
  • Glycopyrrolate
  • Humans
  • Nebulizers and Vaporizers
  • State Medicine
  • Tiotropium Bromide / therapeutic use

Substances

  • Adrenal Cortex Hormones
  • Drug Combinations
  • Fumarates
  • Beclomethasone
  • Glycopyrrolate
  • Formoterol Fumarate
  • Tiotropium Bromide

Associated data

  • ClinicalTrials.gov/NCT02676076
  • ClinicalTrials.gov/NCT02676089