(320) Cost-effectiveness of triple therapy compared to dual therapy in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the major public health problems worldwide, and it is estimated to be the third leading cause of death by 2030. Economic concerns persist in the choice between dual therapy and triple therapy in COPD.

Objectives: To compare the cost-effectiveness of triple therapy with dual therapy in terms of exacerbations and quality-adjusted life years (QALYs) in patients with COPD.

Methods: A systematic search was performed in PubMed, Google Scholar, Scopus, and Cost-Effectiveness Analysis (CEA) Registry for eligible cost-effectiveness and cost–utility studies published up to 31st December 2023. Different monetary units were extracted and converted to purchasing power parity and adjusted to 2023 U.S. Dollars. We pooled the incremental net benefits (INBs) of QALYs and exacerbations of triple therapy compared with dual therapy in COPD. The Fixed or Random-effects model was used based on the heterogeneity identified using the I² statistic and Cochran's Q test. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020) were followed for conducting the systematic review.

Results: Out of 1016 studies, 10 were eligible, predominantly from high-income countries. In the comparison of triple therapy to dual therapy INB of QALYs was determined to be US$4969.19 (95% CI US$3620.16 to US$6318.21), indicating a substantial degree of heterogeneity. In subgroup analysis Budesonide/Glycopyrrolate/Formoterol fumarate (B/G/F) demonstrated an INB of US$5717.96, Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) had an INB of US$5675.90, and Tiotropium/Fluticasone/Salmeterol (TFS) showed a slightly negative INB. For exacerbations, the pooled INB was US$21163.81(95% CI US$4788.62 to US$37539.00). B/G/F showing the highest positive INB of US$45540.51, followed by FF/UMEC/VI(US$14832.51) and TFS(US$10249.29), respectively.

Conclusions: The meta-analysis results reveal the cost-effectiveness of triple therapy, particularly B/G/F in comparison to dual therapy concerning both QALYs and exacerbations. However, the substantial heterogeneity underscores the imperative for additional research and comprehensive insights in this domain.