Budgetary impact on a U.S. health plan after adopting umeclidinium/vilanterol (UMEC/VI) for the management of moderate-to-severe COPD

BACKGROUND:
A new treatment for chronic obstructive pulmonary disease (COPD), is a combination of two drugs: umeclidinium (UMEC), an anticholinergic agent, and vilanterol (VI), a long-acting beta agonist (LABA). UMEC/VI is indicated for once-daily maintenance of airflow obstruction in patients with COPD. Understanding the budgetary impact of including UMEC/VI on formulary while considering other COPD maintenance treatments will aid in population health-based decision making.

OBJECTI VE: To estimate the budgetary impact on costs and outcomes of UMEC/VI for managing COPD in a U.S. commercial and Medicare health plan population.

METHODS: A decision model was developed to compare COPD maintenance therapy costs and outcomes with and without formulary adoption of UMEC/VI for a hypothetical 1 million member plan over a 4-year time horizon. A disease progression model was used to follow the COPD patient population as they progressed through COPD stages over this time horizon. COPD incidence and prevalence was derived from published sources to identify the COPD population of interest. The primary outcomes of interest are total annual and permember per-month (PMPM) costs, which include drug and medical costs. These costs are estimated for both a status quo market mix without UMEC/VI and a projected market mix once UMEC/VI is added to formulary. The incremental budget impact on medication costs, including medication augmentation due to inclusion of UMEC/ VI was estimated. Forced expiratory volume in 1 s improvement was linked to exacerbations to describe the medical cost impact. Other COPD regimens considered in this analysis include tiotropium (TIO), open dual bronchodilator therapy (TIO administered once daily and LABA administered twice daily), and no long-acting bronchodilator therapy. Drug costs were based on 2014 wholesale acquisition costs.

RESULTS: When UMEC/VI is not on formulary, the total PMPM (including drug and medical costs) for moderate to very severe COPD is $16.23, $19.98, $21.64, and $23.15 for 2014-2017, respectively. The addition of UMEC/VI on formulary reduces the total PMPM to $16.13, $19.74, $21.27, and $22.64, which is a reduction of $0.10, $0.24, $0.36 and $0.52 for 2014-2017, respectively. With this decrease in costs also comes a decrease in the occurrence of exacerbations within the population.

CONCLUSIONS: It is anticipated that including UMEC/VI on a formulary will result in a decrease in maintenance medication costs and medical costs within the population over the 4-year period following introduction.