Impact of Budesonide/Glycopyrronium/Formoterol Initiation on Healthcare Resource Utilization and Estimated Associated Costs and Greenhouse Gas Emissions Across COPD Care in Spain (ORESTES* Study)

Introduction Chronic obstructive pulmonary disease (COPD) is associated with substantial healthcare resource utilization (HCRU), high healthcare costs, and a considerable environmental burden. Triple therapy, such as budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF), is recommended for patients with COPD not adequately controlled by dual therapy. Real-world assessments of the economic and environmental implications of COPD treatment strategies remain limited. This study estimated the impact of BGF initiation on HCRU-related costs and greenhouse gas (GHG) emissions in Spain. Methods This post hoc analysis used data from the multicenter, observational, retrospective ORESTES study. Adult patients with COPD who had initiated BGF and had at least 12 months of clinical data before treatment initiation were included. HCRU and actual use of short-acting β-2 agonists (SABA) were assessed before and after BGF initiation, and associated costs and GHG emissions were estimated using unit costs and emission factors from the perspective of the Spanish National Health System. Results A total of 718 patients were included. Following BGF initiation, annualized rates of hospitalizations, hospitalized days, emergency room admissions, primary care visits, and actual SABA use decreased by 12.9%, 9.2%, 12.0%, 4.9%, and 25.5%, respectively. Estimated annual HCRU-related costs decreased by €200.11 per patient, from €2599.46 before BGF initiation to €2399.35 after initiation, mainly driven by reduced hospitalization costs. Estimated annual HCRU-related GHG emissions decreased by 25.16 kg CO2e per patient, from 245.43 to 220.27 kg CO2e, primarily because of reductions in hospitalizations and actual SABA use. Conclusions This post hoc analysis estimated reductions in HCRU-related costs and GHG emissions following BGF initiation in patients with COPD in routine clinical practice in Spain. These findings suggest that the clinical and HCRU improvements observed after BGF initiation may translate into meaningful HCRU-related economic and environmental benefits at the healthcare system level, reinforcing the broader value of clinically appropriate COPD treatment optimization. Trial Registration NCT06321731.