Applied Health Economics and Health Policy

, Volume 14, Issue 5, pp 579–594 | Cite as

Cost Effectiveness of the Long-Acting β2-Adrenergic Agonist (LABA)/Long-Acting Muscarinic Antagonist Dual Bronchodilator Indacaterol/Glycopyrronium Versus the LABA/Inhaled Corticosteroid Combination Salmeterol/Fluticasone in Patients with Chronic Obstructive Pulmonary Disease: Analyses Conducted for Canada, France, Italy, and Portugal

  • M. Reza Maleki-Yazdi
  • Mathieu Molimard
  • Dorothy L. Keininger
  • Jean-Bernard Gruenberger
  • Joao Carrasco
  • Claudia Pitotti
  • Elsa Sauvage
  • Sara Chehab
  • David Price
Original Research Article



The objective of this study was to assess the cost effectiveness of the dual bronchodilator indacaterol/glycopyrronium (IND/GLY) compared with salmeterol/fluticasone combination (SFC) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) who had a history of one or no exacerbations in the previous year, in Canada, France, Italy, and Portugal.


A patient-level simulation was developed to compare the costs and outcomes of IND/GLY versus SFC based on data from the LANTERN trial (NCT01709903). Monte-Carlo simulation methods were employed to follow individual patients over various time horizons. Population and efficacy inputs were derived from the LANTERN trial. Considering the payers’ perspective, only direct costs were included. Costs and health outcomes were discounted annually at 3.0 % for all countries. Unit costs were taken from publically available sources with all costs converted to euros (€). The cost base year was 2015. Deterministic and probabilistic sensitivity analyses were undertaken to test the robustness of the model results.


IND/GLY was found to be the dominant (more effective and less costly) treatment option compared with SFC in all four countries. The use of IND/GLY was associated with mean total cost savings per patient over a lifetime of €6202, €1974, €1611, and €220 in Canada, France, Italy, and Portugal, respectively. Sensitivity analysis showed that exacerbation rates had the largest impact on incremental costs and quality-adjusted life-years (QALYs). The probability of IND/GLY being cost effective was estimated to be >95 % for thresholds above €5000/QALY.


In patients with moderate to severe COPD, IND/GLY is likely to be a cost-effective treatment alternative compared with SFC.



The authors would like to thank Purnima Pathak (Novartis) for providing writing assistance in the development of this manuscript. The authors would also like to thank Colin Burke and Ronan Mahon (Health Economic Modelers; Novartis) for their modeling support. Medical writing support was funded by Novartis Pharma AG (Basel, Switzerland).

Author contributions

All authors have been involved in reviewing and approving the manuscript. In addition, all authors were responsible for the adaptation of the cost-effectiveness model.

Compliance with Ethical Standards

M. Reza Maleki-Yazdi has acted as a consultant to and received research grants from Almirall, AstraZeneca, Boehringer Ingelheim, Forest Laboratories, GlaxoSmithKline, Novartis, Merck, Ono Pharmaceuticals, and Pfizer. Molimard Mathieu has acted as a consultant to Novartis and GSK. Dorothy Keininger, Jean-Bernard Gruenberger, Joao Carrasco, Claudia Pitotti, Elsa Sauvage, and Sara Chehab are employees of Novartis. David Price has acted as a consultant to Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals, and received grants and unrestricted funding for investigator-initiated studies from the UK National Health Service, British Lung Foundation, Aerocrine, AKL Ltd, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Eli Lilly, GlaxoSmithKline, Meda, Merck, Mundipharma, Napp, Novartis, Orion, Pfizer, Respiratory Effectiveness Group, Takeda, Teva Pharmaceuticals, and Zentiva.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • M. Reza Maleki-Yazdi
    • 1
  • Mathieu Molimard
    • 2
  • Dorothy L. Keininger
    • 3
  • Jean-Bernard Gruenberger
    • 3
  • Joao Carrasco
    • 4
  • Claudia Pitotti
    • 5
  • Elsa Sauvage
    • 6
  • Sara Chehab
    • 7
  • David Price
    • 8
  1. 1.Division of Respiratory MedicineWomen’s College Hospital, University of TorontoTorontoCanada
  2. 2.Department of Medical PharmacologyCHU and University of BordeauxBordeaux CedexFrance
  3. 3.Primary Care Franchise, Novartis Pharma AG, PostfachBaselSwitzerland
  4. 4.Health Economics and Outcomes Research, Novartis Farma–Produtos Farmacêuticos SA.Paço de ArcosPortugal
  5. 5.Health Economics, Novartis Farma S.p.A.OriggioItaly
  6. 6.Strategy Pricing, Novartis Pharma S.A.S.Rueil-Malmaison CedexFrance
  7. 7.Health Policy and Patient Access, Novartis Pharmaceuticals Canada Inc.QuebecCanada
  8. 8.Academic Primary Care, Division of Applied Health SciencesUniversity of AberdeenAberdeenUK

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