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

• Published in: Respiratory research Vol. 15; no. 1; p. 66
• Main Authors: van Boven, Job Fm, Tommelein, Eline, Boussery, Koen, Mehuys, Els, Vegter, Stefan, Brusselle, Guy Go, Rutten-van Mölken, Maureen Pmh, Postma, Maarten J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14-06-2014; BioMed Central
• Subjects: Analysis; Chronic obstructive pulmonary disease; Community Pharmacy Services - economics; Community Pharmacy Services - standards; Comparative analysis; Cost-Benefit Analysis; Drug therapy; Economic analysis; Economic aspects; Female; Humans; Inhalation; Intervention; Lung diseases, Obstructive; Male; Markov chains; Medication Adherence; Nebulizers and Vaporizers - economics; Nebulizers and Vaporizers - standards; Prognosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - epidemiology; Sensitivity analysis
• ISSN: 1465-9921; 1465-993X; 1465-993X; 1465-9921
• DOI: 10.1186/1465-9921-15-66

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.
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.
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.
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.