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

<b>These are peer-reviewed supplementary materials for the article</b><b> </b><b>'</b><b>Cost-effectiveness modeling of mortality risk reduction comparing two fixed-dose combination triple therapies in moderate-to-very severe chronic obstructive pulmonary disease</b><b>'</b><b> </b><b>published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><b>Supplementary methods</b><b>Supplementary Table 1: </b>Model input population characteristics<b>Supplementary Table 2:</b> Patient distribution on the COPD severity levels at the beginning of the time horizon<b>Supplementary Table 3: </b>Exacerbation rates and relative risks<b>Supplementary Table 4: </b>Risk and relative risk of discontinuation by treatment<b>Supplementary Table 5: </b>Treatment-related AE incidence for BGF and relative risk for FF/UMEC/VI<b>Supplementary Table 6: </b>COPD<b> </b>severity level utility value<b>Supplementary Table 7: </b>Exacerbation and AE-related utility decrements used in the base case analysis<b>Supplementary Table 8: </b>COPD management costs based on exacerbations<b>Supplementary Table 9:</b> Drug acquisition costs[7]<b>Supplementary Table 10: </b>Number of rescue medication inhalations required per month per treatment by COPD severity levels and rescue medication acquisition cost[7]<b>Supplementary Table 11:</b> Treatment-related AE management costs[9]<b>Supplementary Table 12:</b> Subsequent treatment costs per month[7]<b>Supplementary Table 13: </b>Total costs for mortality waning<b>Supplementary Table 14: </b>Different mortality distribution<b>Supplementary Figure 1: </b>Linear waning applied in the model<b>Supplementary Figure 2: </b>Graphical representation of COPD health state mortality rates up to lifetime horizon A) moderate COPD and B) severe/very severe COPD<b>Aim:</b> 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 matchingadjusted 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 thirdparty payer perspective.<b> Materials &amp; methods:</b> 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. <b>Results:</b> 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.