Cost-Effectiveness of FF/UMEC/VI vs BUD/GLY/FOR in Moderate-to-Very Severe COPD

BACKGROUND: COPD is a significant cause of morbidity and mortality worldwide and in Colombia. Although single-inhaler triple therapies have demonstrated superior clinical benefits in patients with previous exacerbations, their economic value in middle-income settings remains uncertain. Our objective was to evaluate the long-term cost-effectiveness of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus budesonide/glycopyrronium/formoterol (BUD/GLY/FOR) in Colombian patients with COPD. METHODS: We developed an individual-level microsimulation model to compare FF/UMEC/VI with BUD/GLY/FOR from the Colombian public payer perspective. The model incorporated GOLD-based progression, exacerbations, mortality, dynamic adherence functions, costs, and utilities derived from a Colombian cohort study. RESULTS: FF/UMEC/VI increased QALYs by 0.51 and saved USD 1,038 per patient, remaining dominant across deterministic and probabilistic sensitivity analyses. Net monetary benefit (NMB) was higher with FF/UMEC/VI. After 10,000 microsimulations, FF/UMEC/VI showed > 95% probability of cost-effectiveness at Colombia's willingness to pay of USD 5,180/QALY. CONCLUSIONS: This is the first economic evaluation of FF/UMEC/VI and BUD/GLY/FOR in Colombia, incorporating local real-world data and adherence. Results demonstrate that FF/UMEC/VI is a cost-effective and often dominant option, supporting its adoption in resource-limited settings.