Impact of Increased Single-Inhaler Triple Therapy Use in Appropriate Patients on Chronic Obstructive Pulmonary...

Introduction: Chronic obstructive pulmonary disease (COPD) is the third cause of death in Spain. The ETHOS (NCT02465567) and IMPACT (NCT02164513) RCTs showed reduced exacerbations and all-cause mortality for single-inhaler triple therapy (SITT), but no studies have evaluated the potential impact on COPD outcomes of higher SITT adoption in Spain.

We used literature-based data on patient characteristics, incidence, COPD severity changes, treatment distributions/transitions, mortality, exacerbations, and medical costs, to inform a stochastic simulation of the Spanish COPD population for 2025-2034 under two scenarios: "status quo" and "increased SITT," in which higher SITT use is driven by airflow limitation, exacerbation history (as per 2025 GOLD report), and SITT replacing multiple-inhaler triple therapy. Additionally, we present results separately for the subset of patients that met the criteria for SITT use, referred to as "flagged population."

In our 10-year simulation, increased SITT use in the flagged population could lead to 51,000 deaths avoided resulting in a 14.6% reduction in mortality rates and extended patient life by 1.2 years per COPD-flagged patient. Additionally, increased SITT use in the flagged population reduced severe and moderate exacerbations by 62,000 (an 11.5% reduction) and 366,000 (an 11.6% reduction), respectively, resulting in total medical savings of EUR 384 million.

Based on our simulation, increased use of SITT in the Spanish COPD population, consistent with the most recent 2025 GOLD report recommendations, could reduce mortality and exacerbations and their corresponding medical costs. Increasing SITT utilization in patients with COPD may constitute a long-term strategy with relevant clinical and economic benefits.