"Beyond triple Therapy: Is dupilumab a cost-effective option for COPD with type 2 inflammation?"

COPD causes significant morbidity and mortality globally. A subset of patients with type 2 inflammation and elevated eosinophils experience frequent exacerbations despite optimal inhaled therapy. Dupilumab has shown efficacy in this population, but its cost-effectiveness remains uncertain, particularly in middle-income countries.

A Markov model simulated disease progression in moderate-to-very severe COPD with monthly cycles over a lifetime horizon. Clinical efficacy data were sourced from the BOREAS and NOTUS trials. Costs and utilities were based on Colombian data, updated to 2024 USD. Analyses were conducted from the Colombian health system perspective using a 5 % discount rate. A $5180/QALY threshold was applied. Sensitivity and scenario analyses were performed.

Dupilumab added 2.41 QALYs at an additional cost of $31,072, yielding an ICER of $12,905/QALY-exceeding the Colombian threshold. The net monetary benefit was lower for dupilumab than for standard care. Sensitivity analysis showed cost-effectiveness was only achieved if the drug cost dropped below $238/month. Scenario analyses simulating shorter effect duration further worsened cost-effectiveness. Dupilumab was not cost-effective in 100 % of PSA iterations.

At current pricing, dupilumab is not cost-effective for eosinophilic COPD in Colombia. Pricing adjustments or outcome-based agreements are necessary for sustainable adoption.