Abstract：
BACKGROUND: This cost-utility analysis assessed the long-term clinical and economic benefits of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy vs FF/VI or UMEC/VI from a Quebec societal perspective in patients with chronic obstructive pulmonary disease (COPD) with ≥1 moderate/severe exacerbation in the previous year.
METHODS: The validated GALAXY disease progression model was utilized, with parameters set to baseline and efficacy data from IMPACT. Treatment costs (2017 Canadian dollars [C$]) were estimated using Quebec-specific unit costs. Costs and health outcomes were discounted at 1.5 %/year. A willingness-to-pay threshold of C$50,000/quality-adjusted life year (QALY) was considered cost-effective. Outcomes modeled were exacerbation rates, QALYs, life years (LYs), costs and incremental cost-effectiveness ratios (ICERs). Subgroup analyses were performed according to prior treatment, exacerbation history in the previous year, and baseline lung function.
RESULTS: Over a lifetime horizon, FF/UMEC/VI resulted in more QALYs and LYs gained, at a small incremental cost compared with FF/VI and UMEC/VI. From a societal perspective, the estimated ICER for the base case was C$18,152/QALY vs FF/VI, and C$15,847/QALY vs UMEC/VI. For the subgroup analyses (FF/UMEC/VI compared with FF/VI and UMEC/VI), ICERs ranged from: C$17,412-25,664/QALY and C$16,493-18,663/QALY (prior treatment); C$15,247-19,924/QALY and C$15,444-28,859/QALY (exacerbation history); C$14,025-34,154/QALY and C$16,083-17,509/QALY (baseline lung function).
CONCLUSIONS: FF/UMEC/VI was predicted to improve outcomes and be cost-effective vs both comparators in the base case and all subgroup analyses, and based on this analysis would be an appropriate investment of health service funds in Quebec.
BACKGROUND: IMPACT trial NCT02164513.
METHODS: The validated GALAXY disease progression model was utilized, with parameters set to baseline and efficacy data from IMPACT. Treatment costs (2017 Canadian dollars [C$]) were estimated using Quebec-specific unit costs. Costs and health outcomes were discounted at 1.5 %/year. A willingness-to-pay threshold of C$50,000/quality-adjusted life year (QALY) was considered cost-effective. Outcomes modeled were exacerbation rates, QALYs, life years (LYs), costs and incremental cost-effectiveness ratios (ICERs). Subgroup analyses were performed according to prior treatment, exacerbation history in the previous year, and baseline lung function.
RESULTS: Over a lifetime horizon, FF/UMEC/VI resulted in more QALYs and LYs gained, at a small incremental cost compared with FF/VI and UMEC/VI. From a societal perspective, the estimated ICER for the base case was C$18,152/QALY vs FF/VI, and C$15,847/QALY vs UMEC/VI. For the subgroup analyses (FF/UMEC/VI compared with FF/VI and UMEC/VI), ICERs ranged from: C$17,412-25,664/QALY and C$16,493-18,663/QALY (prior treatment); C$15,247-19,924/QALY and C$15,444-28,859/QALY (exacerbation history); C$14,025-34,154/QALY and C$16,083-17,509/QALY (baseline lung function).
CONCLUSIONS: FF/UMEC/VI was predicted to improve outcomes and be cost-effective vs both comparators in the base case and all subgroup analyses, and based on this analysis would be an appropriate investment of health service funds in Quebec.
BACKGROUND: IMPACT trial NCT02164513.
摘要：
背景：这项成本效用分析从魁北克社会的角度评估了糠酸氟替卡松/灭替溴铵/维兰特罗（FF/UMEC/VI）三联疗法与FF/VI或UMEC/VI治疗的长期临床和经济效益。
方法：使用经过验证的GALAXY疾病进展模型，参数设置为基线，疗效数据来自IMPACT。治疗费用（2017加元[C$]）是使用魁北克特定的单位成本估算的。费用和健康结果以1.5%/年折扣。支付意愿阈值为50,000加元/质量调整生命年(QALY)被认为是具有成本效益的。结果模型是恶化率，QALYs,生命年(LYs)，成本和增量成本效益比(ICER)。根据之前的治疗进行亚组分析，前一年的恶化史，和基线肺功能。
结果：在一生中，FF/UMEC/VI获得了更多的QALY和LYs，与FF/VI和UMEC/VI相比，增量成本较小。从社会的角度来看,基本情况下的估计ICER为18,152加元/季度vsFF/VI，和15847加元/季度对UMEC/VI。对于亚组分析（FF/UMEC/VI与FF/VI和UMEC/VI相比），ICERs范围为：C$17,412-25,664/QALY和C$16,493-18,663/QALY（先前治疗）；C$15,247-19,924/QALY和C$15,444-28,859/QALY（恶化史）；C$14,025-34,154/QALY和C$16,083-17,509
结论：FF/UMEC/VI在基础病例和所有亚组分析中相对于两个比较者而言，预测可改善结局并具有成本效益。基于这一分析，将是魁北克卫生服务基金的适当投资。
背景：影响试验NCT02164513。
方法：使用经过验证的GALAXY疾病进展模型，参数设置为基线，疗效数据来自IMPACT。治疗费用（2017加元[C$]）是使用魁北克特定的单位成本估算的。费用和健康结果以1.5%/年折扣。支付意愿阈值为50,000加元/质量调整生命年(QALY)被认为是具有成本效益的。结果模型是恶化率，QALYs,生命年(LYs)，成本和增量成本效益比(ICER)。根据之前的治疗进行亚组分析，前一年的恶化史，和基线肺功能。
结果：在一生中，FF/UMEC/VI获得了更多的QALY和LYs，与FF/VI和UMEC/VI相比，增量成本较小。从社会的角度来看,基本情况下的估计ICER为18,152加元/季度vsFF/VI，和15847加元/季度对UMEC/VI。对于亚组分析（FF/UMEC/VI与FF/VI和UMEC/VI相比），ICERs范围为：C$17,412-25,664/QALY和C$16,493-18,663/QALY（先前治疗）；C$15,247-19,924/QALY和C$15,444-28,859/QALY（恶化史）；C$14,025-34,154/QALY和C$16,083-17,509
结论：FF/UMEC/VI在基础病例和所有亚组分析中相对于两个比较者而言，预测可改善结局并具有成本效益。基于这一分析，将是魁北克卫生服务基金的适当投资。
背景：影响试验NCT02164513。
