Is dual bronchodilation a cost-effective alternative to ICS/LABA in COPD? A Colombian healthcare system evaluation.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major public health challenge in Colombia, particularly among older adults. Although ICS/LABA combinations like fluticasone/salmeterol (FSC) are widely used, dual bronchodilation with umeclidinium/vilanterol (UMEC/VI) may offer clinical and economic advantages.The objective of this paper is to evaluate the long-term cost-effectiveness of UMEC/VI versus FSC in patients with moderate to severe COPD from the perspective of the Colombian healthcare system.

METHODS: A Markov model with four health states (moderate, severe, very severe COPD, and death) simulated the disease course over a lifetime horizon. Clinical efficacy and utilities were derived from randomized trials and meta-analyses; costs were sourced from national databases. Deterministic and probabilistic sensitivity analyses assessed uncertainty. The economic advantage of UMEC/VI was primarily driven by its ability to reduce moderate and severe exacerbations, which represent nearly 88% of total COPD-related healthcare costs in Colombia.

RESULTS: UMEC/VI yielded 8.74 additional QALYs compared to FSC, with an incremental cost of $7,039 USD, resulting in an ICER of $805 per QALY-well below Colombia's WTP threshold of $5,180. Sensitivity analyses confirmed model robustness; UMEC/VI remained cost-effective in 64% of simulations.

CONCLUSION: UMEC/VI is a highly cost-effective alternative to FSC for moderate to severe COPD in Colombia, offering improved clinical outcomes and economic value for resource-constrained health systems.