Indacaterol/glycopyrronium is cost-effective compared to salmeterol/fluticasone in COPD: FLAME-based modelling in a Swedish population

Research output: Contribution to journalArticle


Background: This study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year. Methods: A previously published and validated patient-level simulation model was adapted using clinical data from the FLAME trial and real-world cost data from the ARCTIC study. Costs (total monetary costs comprising drug, maintenance, exacerbation, and pneumonia costs) and health outcomes (life-years (LYs), quality-adjusted life-years (QALYs)) were projected over various time horizons (1, 5, 10 years, and lifetime) from the Swedish payer's perspective and were discounted at 3% annually. Uncertainty in model input values was studied through one-way and probabilistic sensitivity analyses. Subgroup analyses were also performed. Results: IND/GLY was associated with lower costs and better outcomes compared with SFC over all the analysed time horizons. Use of IND/GLY resulted in additional 0.192 LYs and 0.134 QALYs with cost savings of €1211 compared with SFC over lifetime. The net monetary benefit (NMB) was estimated to be €8560 based on a willingness-to-pay threshold of €55,000/QALY. The NMB was higher in the following subgroups: severe (GOLD 3), high risk and more symptoms (GOLD D), females, and current smokers. Conclusion: IND/GLY is a cost-effective treatment compared with SFC in COPD patients with mMRC dyspnea grade ≥ 2, moderate to very severe airflow limitation, and ≥1 exacerbation in the preceding year.


  • Leif Bjermer
  • Job F.M. van Boven
  • Madlaina Costa-Scharplatz
  • Dorothy L. Keininger
  • Florian S. Gutzwiller
  • Karin Lisspers
  • Ronan Mahon
  • Petter Olsson
  • Nicolas Roche
External organisations
  • Skåne University Hospital
  • University Medical Center Groningen
  • University of Groningen
  • Novartis Sverige AB
  • Novartis Pharma AG
  • Uppsala University
  • Novartis Ireland Limited
  • Paris Descartes University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Health Care Service and Management, Health Policy and Services and Health Economy


  • Chronic obstructive pulmonary disease, Cost-effective, Exacerbation, Indacaterol/glycopyrronium
Original languageEnglish
Article number206
JournalRespiratory Research
Issue number1
Publication statusPublished - 2017 Dec 11
Publication categoryResearch