Cost-effectiveness of the LABA/LAMA dual bronchodilator QVA149 in a Swedish setting

Background QVA149 is a new once-daily dual bronchodilator in development for COPD combining a LABA (indacaterol; IND) and LAMA (glycopyrronium; GLY). Objective Determine cost-effectiveness of QVA149 vs the free combination (IND+GLY) and vs the fixed-dose combination of salmeterol/fluticasone (SFC), in a low-exacerbation risk population. Method A cost-minimization analysis compared QVA149 vs IND+GLY. Model inputs were derived from a double-blind randomized QVA149 trial, assuming long-term efficacy and safety equivalence. Cost-effectiveness of QVA149 vs SFC was analysed using model inputs from ILLUMINATE and TORCH (Vogelmeier Lancet Resp Med 2013; Calverley NEJM 2007). Daily drug and healthcare costs (SEK) were derived from the Swedish National Formulary of Drugs. Results At price parity QVA149 was cost neutral vs IND+GLY (all time horizons). When discounted to 90% QVA149 was cost-minimizing at all time horizons with incremental savings of SEK(EUR) 765(89), 2112(245), 3297(382) and 5590(648) per patient over 1,3,5+10 years (8704[1008] over a lifetime). QVA149 was more cost-effective than SFC dominating at all time horizons at price parity and when discounted to 90% (Table). For QVA149 vs SFC cost per exacerbation avoided was SEK6338–10167(734–1178) over a lifetime. Conclusion QVA149 is cost-minimizing vs the free combination of IND+GLY and dominates SFC. Cost-effectiveness analysis (QVA149 vs SFC). Model assumes QVA149 price range of price parity to 90% cost of the free combination Horizon (years) Incremental total costs (SEK, price parity to 90% cost) Incremental LYs Incremental QALYs ICER (SEK/LY) ICUR (SEK/QALY) 1 −894 to −1663 0.000 0.002 Dominant Dominant Lifetime −15,100 to −24,332 0.282 0.198 Dominant Dominant