OBJECTIVES: Uncontrolled asthma increases the likelihood of exacerbations, emergency care, and hospitalizations, and negatively impacts patients’ health-related quality of life. This analysis evaluated the cost-effectiveness of single-inhaler, high-dose indacaterol acetate (IND)/glycopyrronium bromide (GLY)/mometasone furoate (MF) (150/50/160μg, once-daily) versus high-dose salmeterol/fluticasone (SAL/FLU, 50/500µg, twice daily) + tiotropium (Tio, 5µg, once daily) and, high-dose SAL/FLU (50/500µg, twice-daily) for patients with uncontrolled moderate-to-severe asthma from a Canadian health care payer perspective.

METHODS: A lifetime Markov model consisting of two health states (day-to-day symptoms with exacerbations and death) was developed. Canadian costs ($CAD, 2020) were applied to health care resource utilization and treatments. Model cycle length was 4 weeks to correspond with the average duration of an asthma exacerbation. Future costs and cost outcomes were discounted 1.5% annually. Patient characteristics, exacerbation rates, and utilities were derived from the ARGON and IRIDIUM trials. Analyses were probabilistic, and outputs included exacerbation rates, costs, life-years, quality adjusted life-years (QALY) gained, and the incremental cost-effectiveness ratio (ICER).

RESULTS: When the analysis is based on the ARGON trial clinical data, IND/GLY/MF total costs were $33,481 versus $50,910 for SAL/FLU+Tio. Discounted QALYs for IND/GLY/MF were 18.38 versus 18.07 for SAL/FLU+Tio. For IRIDIUM data, total costs were $33,417 for IND/GLY/MF versus $36,589 for SAL/FLU. Discounted QALYs for IND/GLY/MF were 19.33 versus 19.05 for SAL/FLU. QALYs were higher for IND/GLY/MF compared with SAL/FLU+Tio and SAL/FLU due to the higher reduction in exacerbations and associated disutility. The total cost of IND/GLY/MF was lower compared with SAL/FLU+Tio and SAL/FLU. IND/GLY/MF was the dominant treatment strategy compared with SAL/FLU+Tio and SAL/FLU across the trials.

CONCLUSIONS: At a willingness-to-pay threshold of $50,000/QALY, treatment with IND/GLY/MF is cost-effective in patients with uncontrolled moderate-to-severe asthma compared with SAL/FLU+Tio or SAL/FLU from a Canadian health care payer perspective.