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

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