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Research Article
15 December 2025

Cost-effectiveness modeling of mortality risk reduction comparing two fixed-dose combination triple therapies in moderate-to-very severe chronic obstructive pulmonary disease

Authors: Krishnali Parsekar [email protected], Shubhram Pandey, Deniz Tansey-Dwyer, Jonathan Marshall, Isabella Rustignoli, Michael Pollack, Barinder Singh, and Mario OuwensAuthor Info & Affiliations
Volume 15, Number 1
https://doi.org/10.57264/cer-2025-0111
PDFFormats

Abstract

Aim: Two fixed-dose combination triple therapies, budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) 320/14.4/10 μg and fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 μg, have been shown to reduce all-cause mortality in phase III trials. A recent matching-adjusted indirect comparison showed greater mortality reduction with BGF versus FF/UMEC/VI. However, the comparative cost-effectiveness of these treatments remains unknown. This study aimed to use a cost-effectiveness model to compare BGF with FF/UMEC/VI in patients with moderate-to-very severe chronic obstructive pulmonary disease (COPD) who are eligible for triple therapy from a UK third-party payer perspective. Materials & methods: A cohort-based semi-Markov model was used with the natural progression of COPD defined by four lung function levels. Input parameters included participant characteristics and clinical efficacy parameters derived from the ETHOS and KRONOS trials, the UK general population and published literature. Unit costs were obtained from the UK National Health System Schedule of Reference Costs (2021/2022), the Personal Social Services Research Unit (2022) and published literature. Outputs included an incremental cost-effectiveness ratio, costs, quality-adjusted life years and life years at time horizons of 1 and 5 years. Model inputs and assumptions were subject to deterministic and probabilistic sensitivity and scenario analyses. Results: At both 1- and 5-year time horizons, BGF was less costly (-£7.24 and -£23.03 per patient) and more effective (0.002 and 0.21 quality-adjusted life years per patient) versus FF/UMEC/VI, respectively. Due to a reduced mortality rate, more patients remained on BGF treatment than on FF/UMEC/VI, which induced higher treatment-related costs; however, the latter was offset by decreased end-of-life costs, as BGF avoided more deaths. Conclusion: BGF may improve health outcomes and reduce healthcare costs compared with FF/UMEC/VI in patients with moderate-to-very severe COPD in a UK setting.

Plain language summary: comparing costs & benefits of two treatments for COPD

What is this article about?

Chronic obstructive pulmonary disease (COPD) is a serious lung disease that makes breathing difficult and worsens over time. COPD greatly impacts healthcare systems and a person’s quality of life. This study examined two inhaler treatments for COPD: budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) and fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI). We aimed to understand which treatment was more effective at lowering healthcare costs, improving quality of life and reducing death in a UK setting.

What methodology/protocol is described?

COPD guidelines recognize that BGF and FF/UMEC/VI lower the risk of death, but a comparison of costs is lacking. A cost-effectiveness model was developed using phase III clinical trials with BGF and a published matching-adjusted indirect treatment comparison study of BGF and FF/UMEC/VI. The model evaluated the total healthcare costs and health benefits of BGF and FF/UMEC/VI inhaler treatments over 1- and 5-year periods in COPD that worsened over time.

What were the results?

The model showed that BGF was less costly and more effective compared with FF/UMEC/VI because it reduced deaths, which led to lower end-of-life care costs, even when taking BGF for a longer period.

Why is this important?

This study suggests that BGF not only improves patient health outcomes but could also reduce healthcare costs within the duration of 1 to 5 years. The findings support the use of BGF as a cost-effective treatment for patients with COPD, which may lead to better management of this disease.

Supplementary Material

File (supplementary figure 1.eps)
File (supplementary figure 2.eps)
File (supplementary materials.docx)

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