Effectiveness, Utility, and Economic Analysis of Three-drug Treatment vs Two-drug Treatment in Chronic Obstructive Pulmonary Disease Patients

Aim and background: Inhaled corticosteroids (ICS) and bronchodilators remain the mainstay of therapeutic modalities available for the management of chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effectiveness, utility, and economic analysis of a three-drug treatment vs a two-drug treatment in COPD patients. Materials and methods: An observation was conducted at a superspecialty hospital in Hyderabad. Out of the 115 patients recruited from the inpatient and outpatient wards of the Pulmonology Department, 55 patients received triple therapy containing ICS, long-acting β-agonists (LABA), and long-acting muscarinic antagonists (LAMA), whereas 60 patients were treated with dual therapy comprising ICS/LABA. Cost-effectiveness was assessed based on forced expiratory volume in 1 second (FEV1) (FEV1% predicted), St George’s respiratory questionnaire (SGRQ) scores, SGRQ responder ratio, COPD assessment test (CAT) scores, and incremental cost-effectiveness ratio (ICER). Results: Results signified the enhanced potency of three-drug treatment vs two-drug treatment as proven by the improvement in average difference from initial values in (1) FEV1% predicted value of 4.36 [95% confidence interval (CI) (2.9–5.82)], (2) SGRQ scores of −6.76 [95% CI (−2.14 to −11.38)], SGRQ responder ratio of 13.25 (3.72–47.24), CAT scores of −5.15 [95% CI (−9.87 to −0.43)] and ICER of 3522 [95% CI (14682 to −7638)]. Conclusion: Triple therapy comprising LABA, LAMA, and ICS can optimize lung function and improve clinical outcomes, leading to overall enhancement of well-being compared to LABA/ICS dual therapy in moderate to severe COPD patients. Clinical significance: Three-drug treatment comprising ICS/LABA/LAMA is an effective and cost-effective therapeutic approach for managing moderate and severe COPD compared to ICS/LABA dual therapy. This is evidenced by improvements in spirometry values (FEV1% predicted) and health-related quality of life (HRQoL).