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Modelling the Cost-Effectiveness of Indacaterol/Glycopyrronium versus Salmeterol/Fluticasone Using a Novel Markov Exacerbation-Based Approach

Authors Lakhotia B, Mahon R, Gutzwiller FS, Danyliv A, Nikolaev I, Thokala P

Received 24 January 2020

Accepted for publication 30 March 2020

Published 16 April 2020 Volume 2020:15 Pages 787—797


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Bhavesh Lakhotia,1 Ronan Mahon,1 Florian S Gutzwiller,2 Andriy Danyliv,1 Ivan Nikolaev,2 Praveen Thokala3

1Novartis Ireland Limited, Dublin, Ireland; 2Novartis Pharma, Basel, AG, Switzerland; 3PT Health Economics Ltd, Sheffield, UK

Correspondence: Ronan Mahon
Team Head, Patient Access Services Product Lifecycle Services – Novartis Global Service Center Dublin, Vista Building, Elm Park Business Campus, Dublin 4, Ireland
Tel +353873647443

Purpose: Exacerbations drive outcomes and costs in chronic obstructive pulmonary disease (COPD). While patient-level (micro) simulation cost-effectiveness models have been developed that include exacerbations, such models are complex. We developed a novel, exacerbation-based model to assess the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in COPD, using a Markov structure as a simplification of a previously validated microsimulation model.
Methods: The Markov model included three health states: infrequent or frequent exacerbator (IE or FE; ≤ 1 or ≥ 2 moderate/severe exacerbations in prior 12 months, respectively), or death. The model used data from the FLAME study and was run over a 10-year horizon. Cycle length was 1 year, after which patients remained in the same health state or transitioned to another. Analysis was conducted from a Swedish payer’s perspective (Swedish healthcare costs, converted into Euros), with incremental costs and quality-adjusted life-years (QALYs) calculated (discounted 3% annually).
Results: At all post-baseline timepoints, IND/GLY was associated with more patients in the IE health state and fewer patients in the FE and dead states relative to SFC. Over a 10-year period, IND/GLY was associated with a cost saving of € 1,887/patient, an incremental benefit of 0.142 QALYs, and an addition of 0.057 life-years, compared with SFC.
Conclusion: This Markov model represents a novel cost-effectiveness analysis for COPD, with simpler methodology than prior microsimulation models, while retaining exacerbations as drivers of disease progression. In patients with COPD with a history of exacerbations in the previous year, IND/GLY is a cost-effective treatment option compared with SFC.

Keywords: chronic obstructive pulmonary disease, indacaterol/glycopyrronium, cost-effective, exacerbation, Markov model

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