Implementation of 2023 Canadian Thoracic Society Guidelines for Single-Inhaler Triple Therapy Could Reduce Exacerbation and Mortality Rates in COPD: PROMETHEUS Canada.

Abstract

Background: Chronic Obstructive Pulmonary Disorder (COPD) is the fifth leading cause of death in Canada. The ETHOS (NCT02465567) and IMPACT randomized controlled trials (RCT) (NCT02164513) demonstrated reduced exacerbations and all-cause mortality for patients with COPD on single-inhaler triple therapy (SITT). The 2023 Canadian Thoracic Society (CTS) COPD Pharmacotherapy guidelines recommend triple therapy and preferably SITT use in patients with moderate/severe symptom burden and high future risk of exacerbations. The clinical impact of broader SITT use in Canada has not yet been studied.

Aim: To estimate the benefit of appropriate SITT use according to CTS COPD guidelines on mortality, exacerbations and their corresponding costs in Canada.

Methods: A stochastic model using literature-derived characteristics (e.g. incidence, changes in COPD severity, treatment, mortality, and exacerbations) simulated the Canadian COPD population. Patients were assigned % of FEV₁ predicted levels and their annual characteristics were modeled for 2025-2034 under 2 scenarios: "status quo" (current practice) and "increased SITT" (following CTS guidelines).

Results: Based on our simulated results for the flagged population, "Increased SITT" use over 10 years compared to current treatment reduced moderate and severe exacerbation rates by 23% and 12%, respectively, for a reduction of 159,000 severe and 2.81 million moderate exacerbations and reduced all-cause mortality rate by 22%. In the flagged population alone, this reduction in exacerbations would equate to a savings of CA$3.9 billion over 10 years.

Conclusion: Appropriate use of SITT informed by the 2023 CTS COPD guidelines could lower mortality, exacerbation frequency and their corresponding costs in patients with COPD.