OBJECTIVES

Real-world evidence suggests that triple therapy (long-acting β₂ agonist, long-acting muscarinic antagonist, and inhaled corticosteroids [ICS]) is being over-utilised in COPD patients. Whilst triple therapy has a role in specific patient groups, these benefits can come at the expense of an increase in pneumonia and other adverse events and can increase costs. We analysed the relationship between HTA recommendations and market penetration of the two new FDC triple therapies: glycopyrronium bromide/formoterol fumarate/beclomethasone (Trimbow®) and umeclidinium/vilanterol/fluticasone furoate (Trelegy Ellipta).

METHODS

HTA recommendations in ten countries were evaluated. Number of doses per quarter of a year were extracted from international prescribing data (Q3 2017 to Q1 2020). Days of therapy were calculated by dividing the number of doses by average daily dose. Market share was determined using days of therapy as a percentage of total market share for long-acting bronchodilators. We calculated the average market penetration and assessed the distance each country was away from the average.

RESULTS

In general, countries where HTA evaluations have taken place with restrictions imposed on the use of FDC triple therapy, saw a lower than average uptake. Restrictions included: access to only patients stable on open combination triple (Spain, Netherlands) or not controlled on dual therapy (Canada), requirement of a specialist prescription (Italy, France) or therapeutic plan (Italy), access only to patients with severe disease (France, Australia), and no use as initial therapy (Canada, Australia).

CONCLUSIONS

Overuse of ICS-based regimens has both humanistic and economic implications. Initiatives aimed at restricting the use of FDC triple therapy leads to lower than average prescribing rates and potentially more appropriate use. It is essential for payers to assess the range of factors, including the risks and benefits of triple FDCs, and consider which restrictions would ensure the most efficient use of limited healthcare resources.