Cost-effectiveness of combination fluticasone propionate–salmeterol 250/50 μg versus salmeterol in severe COPD patients

Anand A Dalal¹, Meaghan St Charles², Hans V Petersen², Melissa H Roberts², Christopher M Blanchette², Kathy Manavi-Zieverink³

¹US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC, ²Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Kannapolis USA; ³INC Research, Raleigh; NC, USA

Objective: To estimate the cost-effectiveness of fluticasone propionate–salmeterol combination (FSC) compared to salmeterol for maintenance therapy in severe chronic obstructive pulmonary disease (COPD).

Study design: Pooled economic analysis.

Methods: We performed an economic analysis of pooled data from two randomized clinical trials (combined N = 1554) that evaluated the effect of maintenance therapy with FSC (250/50 μg twice daily) or salmeterol (50 μg twice daily) on exacerbation rates in patients with severe COPD. We calculated exacerbation rates and applied standardized costs to exacerbation-related health care utilization reported in the trials (office, urgent care, and emergency department visits; hospitalizations; and oral corticosteroids and antibiotics) to determine cost differences between FSC and salmeterol treatment outcomes.

Results: Annual rates of any exacerbation and moderate/severe exacerbation were lower in the FSC group than the salmeterol group (4.91 vs 5.78 and 1.32 vs 2.00 respectively, both P < 0.05). Total adjusted annual COPD related exacerbation and therapeutic costs were $4,842 (95% CI; $4,731–$4,952) in the FSC group and $5,066 (95% CI; $4,937–$5,195) in the salmeterol group.

Conclusions: FSC combination therapy is associated with reduced risk of any exacerbation and moderate/severe exacerbation, and incurs lower annual COPD-related health care costs compared to treatment with salmeterol. This analysis demonstrates that FSC therapy may be advantageous from both a clinical and cost-benefit standpoint for patients with severe COPD.

Keywords: COPD, cost-effectiveness analysis, economic, maintenance therapy