TY - JOUR T1 - Is single-inhaler triple therapy for COPD cost-effective in the UK? The IMPACT trial JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00333-2021 SP - 00333-2021 AU - Alan Martin AU - Dhvani Shah AU - Kerigo Ndirangu AU - Glenn A Anley AU - Gabriel Okorogheye AU - Melanie Schroeder AU - Nancy Risebrough AU - Afisi S Ismaila Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/10/28/23120541.00333-2021.abstract N2 - Background The IMPACT trial demonstrated superior outcomes following 52 weeks of once-daily single-inhaler treatment with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 μg compared with once-daily FF/VI (100/25 μg) or UMEC/VI (62.5/25 μg). This study evaluates the cost-effectiveness of FF/UMEC/VI compared with FF/VI or UMEC/VI for the treatment of chronic obstructive pulmonary disease (COPD) from a United Kingdom National Health Service perspective.Methods Patient characteristics and treatment effects from IMPACT were populated into a hybrid decision tree/Markov economic model. Costs (GB£ inflated to 2018 equivalents) and health outcomes were modelled over a lifetime horizon, with a discount rate of 3.5% per annum applied to both. Sensitivity analyses were performed to test the robustness of key assumptions and input parameters.Results Compared with FF/VI and UMEC/VI, FF/UMEC/VI provided an additional 0.296 and 0.145 life years (LYs; discounted), and 0.275 and 0.118 quality-adjusted life years (QALYs), at an additional cost of £1129 and £760, respectively. Incremental cost-effectiveness ratios (ICERs) for FF/UMEC/VI were £4104/QALY and £3809/LY gained versus FF/VI and £6418/QALY and £5225/LY gained versus UMEC/VI. At a willingness-to-pay threshold of £20 000/QALY, the probability that FF/UMEC/VI was cost-effective was 96% versus FF/VI and 74% versus UMEC/VI. Results were similar in a subgroup reflecting patients recommended triple therapy in the 2019 National Institute for Health and Care Excellence COPD guideline.Conclusions FF/UMEC/VI single-inhaler triple therapy improved health outcomes and was a cost-effective option compared with FF/VI or UMEC/VI for patients with symptomatic COPD and a history of exacerbations in the UK at recognised cost-effectiveness threshold levels.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: A. Martin, G. Anley, G. Okorogheye, M. Schroeder and A.S. Ismaila are/were employees of, and shareholders in, GlaxoSmithKline. A.S. Ismaila is also an unpaid part-time professor at McMaster University, Canada. D. Shah, K. Ndirangu and N. Risebrough are employees of ICON plc. ICON plc. received funding from GlaxoSmithKline to conduct this study but were not paid for development of this manuscript. ER -