title: Cost-effectiveness of the LABA/LAMA dual bronchodilator indacaterol/glycopyrronium in a Swedish healthcare setting.
abstract: BACKGROUND
  Indacaterol/glycopyrronium (IND/GLY) is a once-daily inhaled fixed-dose combination of indacaterol (IND), a long-acting β2-adrenergic agonist (LABA), and glycopyrronium (GLY), a long-acting muscarinic antagonist (LAMA) for use as maintenance treatment to relieve symptoms of chronic obstructive pulmonary disease (COPD) in adults.
  
  
  OBJECTIVE
  To determine the economic benefits of IND/GLY compared with the free combination of indacaterol and glycopyrronium (IND + GLY), and with the fixed-dose combination of salmeterol/fluticasone (SFC), in a moderate-to-severe COPD population with low-exacerbation risk. The model-based analysis extrapolated results up to lifetime time horizon and calculated costs per quality-adjusted life year.
  
  
  METHODS
  Assuming equal efficacy, a cost-minimisation analysis compared IND/GLY vs IND + GLY using model inputs from the double-blind, randomised SHINE trial. The double-blind, randomised ILLUMINATE and TORCH trials were used to analyse cost-effectiveness versus SFC. To consider ICS-related pneumonia events, published odds ratio comparing an ICS-exposed group to a control group of COPD patients was used. Direct and indirect drug costs as well as drug acquisition costs (in Swedish Krona [SEK]) were derived from published Swedish sources. Cost and effects were discounted with 3%. Uncertainty was assessed by one-way and probabilistic sensitivity analyses (PSA).
  
  
  RESULTS
  IND/GLY was cost-saving vs IND + GLY with incremental savings of SEK (EUR) 768 (85), and 3309 (368) per patient over one and five years. IND/GLY was found to be less costly and more effective compared to SFC with cost savings of SEK (EUR) 2744 (303), 8854 (976), 13,938 (1536), 27,495 (3031) and 43,033 (4744) over one, three, five, ten years and lifetime. The PSA indicated that all iterations produced dominant results for IND/GLY.
  
  
  CONCLUSIONS
  IND/GLY is cost-minimising vs IND + GLY and dominates SFC in the maintenance treatment of COPD patients in Sweden. Encouraging dual bronchodilator therapy over an ICS-containing combination results in lower total costs and better outcomes compared to combination therapy including fluticasone in moderate-to-severe COPD patients with low exacerbation risk.
authors.affiliation: Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen AB25 2ZD, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: Primary Care Franchise, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Keininger
authors.affiliation: Novartis Pharma AB, Box 1150, TÄBY, Stockholm S-183 79, Sweden. Electronic address: madlaina.costa-scharplatz@novartis.com.
authors.forename: Madlaina
authors.initials: M
authors.lastname: Costa-Scharplatz
authors.affiliation: Primary Care Franchise, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland.
authors.forename: Karen
authors.initials: K
authors.lastname: Mezzi
authors.affiliation: IMS Health Economics and Outcomes Research, 210 Pentonville Road, London N1 9JY, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Dimova
authors.affiliation: IMS Health Economics and Outcomes Research, 210 Pentonville Road, London N1 9JY, UK.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Asukai
authors.affiliation: Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Ställberg
mesh_terms: D000368:Aged; D000420:Albuterol / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000730:Androstadienes / Q000191:economics / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004338:Drug Combinations; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000187:drug effects; D006024:Glycopyrrolate / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007189:Indans / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D015363:Quinolones / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000068299:Salmeterol Xinafoate; D013548:Sweden
chemical_list: D000730:Androstadienes; D001993:Bronchodilator Agents; D004338:Drug Combinations; D007189:Indans; D015363:Quinolones; D000068299:Salmeterol Xinafoate; C510790:indacaterol; D000068298:Fluticasone; D000420:Albuterol; D006024:Glycopyrrolate
keywords: COPD; Cost-effectiveness; Cost-minimisation; Costs; Economic evaluation