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Randomized Controlled Trial
. 2014 Jun 14;15(1):66.
doi: 10.1186/1465-9921-15-66.

Improving inhaler adherence in patients with chronic obstructive pulmonary disease: a cost-effectiveness analysis

Job Fm van Boven  1 , Eline Tommelein, Koen Boussery, Els Mehuys, Stefan Vegter, Guy Go Brusselle, Maureen Pmh Rutten-van Mölken, Maarten J Postma
Affiliations
Randomized Controlled Trial

Improving inhaler adherence in patients with chronic obstructive pulmonary disease: a cost-effectiveness analysis

Job Fm van Boven et al. Respir Res. .

Abstract

Background: The PHARMACOP-intervention significantly improved medication adherence and inhalation technique for patients with COPD compared with usual care. This study aimed to evaluate its cost-effectiveness.

Methods: An economic analysis was performed from the Belgian healthcare payer's perspective. A Markov model was constructed in which a representative group of patients with COPD (mean age of 70 years, 66% male, 43% current smokers and mean Forced Expiratory Volume in 1 second of % predicted of 50), was followed for either receiving the 3-month PHARMACOP-intervention or usual care. Three types of costs were calculated: intervention costs, medication costs and exacerbation costs. Outcome measures included the number of hospital-treated exacerbations, cost per prevented hospital-treated exacerbation and cost per Quality Adjusted Life-Year. Follow-up was 1 year in the basecase analysis. Sensitivity and scenario analyses (including long-term follow-up) were performed to assess uncertainty.

Results: In the basecase analysis, the average overall costs per patient for the PHARMACOP-intervention and usual care were €2,221 and €2,448, respectively within the 1-year time horizon. This reflects cost savings of €227 for the PHARMACOP-intervention. The PHARMACOP-intervention resulted in the prevention of 0.07 hospital-treated exacerbations per patient (0.177 for PHARMACOP versus 0.244 for usual care). Results showed robust cost-savings in various sensitivity analyses.

Conclusions: Optimization of current pharmacotherapy (e.g. close monitoring of inhalation technique and medication adherence) has been shown to be cost-saving and should be considered before adding new therapies.

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Figures

Figure 1
Figure 1
Markov model to follow patients with COPD in time. ED: Emergency Department; FEV1% pred: percentage of the predicted Forced Expiratory Volume in 1 second.
Figure 2
Figure 2
Summary of 1-year effects on costs.Usual care: Medication costs (850), Pharmacy fee (0), Exacerbation costs (1598), Total costs (2448); Intervention: Medication costs (934), Pharmacy fee (77), Exacerbation costs (1210), Total costs (2221); Difference (95% CI): Medication costs (84; 44-129), Pharmacy fee (77; 55-104), Exacerbation costs (-388; -225 - -560), Total costs (-227; -58 - -403).
Figure 3
Figure 3
Summary of 1-year effects on hospital-treated exacerbations.Usual care: Hospital Treated (HT) Exacerbations (0.24). Intervention: Hospital Treated (HT) Exacerbations (0.18). Difference (95% CI): Hospital Treated (HT) Exacerbations (-0.07; -0.04 - -0.10).
Figure 4
Figure 4
Probabilistic sensitivity analyses for QALYs. QALY: Quality Adjusted Life-Year.
Figure 5
Figure 5
Probabilistic sensitivity analyses for hospital-treated exacerbations.
Figure 6
Figure 6
Univariate sensitivity analyses. CT: Community Treated; EDT: Emergency Department Treated; HT: Hospital Treated; RR: Relative Risk.
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References

    1. World Health Organization. Chronic obstructive pulmonary disease. http://www.who.int/respiratory/copd/en.
    1. van Boven JF, Vegter S, van der Molen T, Postma MJ. COPD in the working age population: the economic impact on both patients and government. COPD. 2013;10(6):629–639. doi: 10.3109/15412555.2013.813446. - DOI - PubMed
    1. Scientific Institute for Public Health Belgium (WIV-ISP) https://www.wiv-isp.be.
    1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013. http://www.goldcopd.org. - PubMed
    1. Mehuys E, Boussery K, Adriaens E, Van Bortel L, De Bolle L, Van Tongelen I, Remon JP, Brusselle G. COPD management in primary care: an observational, community pharmacy-based study. Ann Pharmacother. 2010;44(2):257–266. doi: 10.1345/aph.1M481. - DOI - PubMed

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