title: 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.
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.
  
  
  CONCLUSIONS
  In patients with moderate to severe COPD, IND/GLY is likely to be a cost-effective treatment alternative compared with SFC.
authors: Division of Respiratory Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada. maleki.pccrc@on.aibn.com.
authors: M
authors: M
authors: Reza Maleki-Yazdi
authors: Department of Medical Pharmacology, CHU and University of Bordeaux, 33076, Bordeaux Cedex, France.
authors: Mathieu
authors: M
authors: Molimard
authors: Primary Care Franchise, Novartis Pharma AG, Postfach, 4002, Basel, Switzerland.
authors: Dorothy L
authors: DL
authors: Keininger
authors: Primary Care Franchise, Novartis Pharma AG, Postfach, 4002, Basel, Switzerland.
authors: Jean-Bernard
authors: JB
authors: Gruenberger
authors: Health Economics and Outcomes Research, Novartis Farma-Produtos Farmacêuticos SA., Paço de Arcos, Portugal.
authors: Joao
authors: J
authors: Carrasco
authors: Health Economics, Novartis Farma S.p.A., Largo Umberto Boccioni 1, 21041, Origgio, VA, Italy.
authors: Claudia
authors: C
authors: Pitotti
authors: Strategy Pricing, Novartis Pharma S.A.S., 2-4, rue Lionel Terray, BP 308, 92506, Rueil-Malmaison Cedex, France.
authors: Elsa
authors: E
authors: Sauvage
authors: Health Policy and Patient Access, Novartis Pharmaceuticals Canada Inc., 385, boulev. Bouchard, CDN-Dorval, Quebec, H9S 1A9, Canada.
authors: Sara
authors: S
authors: Chehab
authors: Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.
authors: David
authors: D
authors: Price
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use*; D002170:Canada; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D000068298:Fluticasone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005602:France; D006024:Glycopyrrolate / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007189:Indans / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D011174:Portugal; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics; D015363:Quinolones / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000068299:Salmeterol Xinafoate / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*
chemical_list: D001993:Bronchodilator Agents; D007189:Indans; D015363:Quinolones; D000068299:Salmeterol Xinafoate; C510790:indacaterol; D000068298:Fluticasone; D006024:Glycopyrrolate