Is treatment with ICS and LABA cost-effective for COPD? Multinational economic analysis of the TORCH study

TORCH was a 3 year multi-centre trial of 6112 patients randomized to: salmeterol (SAL), fluticasone propionate (FP), the FP+SAL combination (SFC), or placebo (PL). Here we assess the cost-effectiveness of treatments evaluated in the TORCH study.Three year all-cause hospitalization, medication, and outpatient care costs were calculated for four regions. The sample was restricted to the 21 countries (n=4237) for which EQ-5D data were collected to estimate quality-adjusted life years (QALYs). Regression models were fitted to survival, study medication cost, other medication cost and EQ-5D data to estimate total cost, QALYs and cost-per-QALY adjusted for missing data and region.SFC had a trial-wide estimate of $43,600 cost per QALY compared with PL (95% CI: 21,400 to 123,500). Estimates for SAL vs. PL ($197,000) and FP vs. PL ($78,000) were less favorable. The US estimates were greater than other regions: for SFC vs. PL the cost-per QALY was $77,100 (46,200 to 241,700) compared to $24,200 (15,200 to 56,100) in Western Europe.Compared with PL, SFC has a lower incremental cost-effectiveness ratio than either FP or SAL used alone and is therefore preferred to these monotherapies on the grounds of cost-effectiveness.