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Mondher Mtibaa,1 Subhajit Gupta,2 Madhusubramanian Muthukumar,2 Jessica Marvel,3 Harneet Kaur,2 Ryotaro Ishikawa,3 Ron Olivenstein4 1Novartis Pharmaceuticals Canada Inc., Dorval, Quebec, Canada; 2Novartis Healthcare Private Limited, Hyderabad, India; 3Novartis Pharma AG, Basel, Switzerland; 4McGill University, Montreal, Quebec, CanadaCorrespondence: Mondher MtibaaNovartis Pharmaceuticals Canada Inc., 385 Bouchard Blvd., Dorval, Quebec, H9S 1A9, CanadaTel +1 514 631-6775 ext. 1367Email mondher.mtibaa@novartis.comPurpose: We evaluated the cost-effectiveness of high-dose indacaterol acetate (IND)/glycopyrronium bromide (GLY)/mometasone furoate (MF) (150/50/160 μg, once daily) compared with high-dose salmeterol/fluticasone (SAL/FLU; 50/500 μg, twice daily)+tiotropium (TIO; 5 μg, once daily) (SAL/FLU+TIO) and with high-dose SAL/FLU (50/500 μg, twice daily) for the treatment of inadequately controlled moderate-to-severe asthma.Patients and Methods: A Markov model estimated the incremental cost-effectiveness ratio of treatment with high-dose IND/GLY/MF compared with SAL/FLU+TIO and high-dose IND/GLY/MF compared with SAL/FLU. The model included three health states (day-to-day symptoms without exacerbations, day-to-day symptoms with exacerbations, and death) with a 4-week cycle length. A lifetime time horizon was used. Exacerbation rates and utility values were derived from ARGON and IRIDIUM clinical trials. Canadian dollars (CAD$, 2020) were applied.Results: IND/GLY/MF was the less costly and more effective treatment strategy compared with SAL/FLU+TIO and SAL/FLU in the base-case analyses. IND/GLY/MF had lower costs (CAD $33,501 versus CAD $50,907) and higher quality-adjusted life-years (QALYs) (18.37 versus 18.06 QALYs) compared with SAL/FLU+TIO. Compared with SAL/FLU, IND/GLY/MF had lower costs (CAD $33,408 versus CAD $36,577) and higher QALYs (19.33 versus 19.04 QALYs). IND/GLY/MF was the most cost-effective option in all scenarios tested.Conclusion: IND/GLY/MF was cost-effective at a willingness-to-pay threshold of CAD $50,000/QALY in patients with uncontrolled, moderate-to-severe asthma versus SAL/FLU+TIO and SAL/FLU in the base case and all scenarios tested.Keywords: moderate to severe asthma, indacaterol acetate, glycopyrronium bromide, mometasone furoate, cost-effectiveness, health care payer perspective, Canada, uncontrolled asthma |