Improving inhaler adherence in patients with Chronic Obstructive Pulmonary Disease: a cost-effectiveness analysis

Abstract

BackgroundThe 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.MethodsAn 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.ResultsIn 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.ConclusionsOptimization 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.

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

“…This is consistent with other studies which show that pharmacist-delivered interventions can lead to significant improvement in medications adherence in other diseases [30,31]. Two studies [23,25,26] in this review showed that the provided interventions were cost-effective in terms of reducing hospitalisation rate and severe exacerbation rate. There was a cost saving of £94.12 per patient (equivalent to €133) for six months in Wright et al [23] study in the UK and €227 per patient for one year in Tommelein et al [25,26] study in Belgium.…”

“…Savings were mainly generated due to the reduction in exacerbation treatment expenses in the IG compared to CG. QALY gain was minimal in this study (<0.001 QALYs) which was attributed mainly to reduction in exacerbations [26].…”

“…Two studies [23,25,26] in this review showed that the provided interventions were cost-effective in terms of reducing hospitalisation rate and severe exacerbation rate. There was a cost saving of £94.12 per patient (equivalent to €133) for six months in Wright et al [23] study in the UK and €227 per patient for one year in Tommelein et al [25,26] study in Belgium. This highlights that IT and MA interventions provided by CPs are not only beneficial for patients but also for the healthcare system.…”

The Economic Impact of Pharmacotherapeutic Follow-Up in Copd Patients at a Health Care Institution in Medellin-Colombia

“…Despite this is a chronic and progressive disease, it is possible to obtain an accurate control with a proper diagnosis and treatment, ensuring an excellent patient compliance in taking its medications [10,11]. This experience has permitted us to determinate the main factors related to therapy failure in COPD patients, such as missing doses and incorrect use of inhaled medications [12][13][14][15][16][17][18][19].…”

Year in Review 2014: COPD

“…14 Regardless of the inhaled medication selected for the management of COPD, improving inhaler technique and adherence should be key targets for health-care professionals working with these patients. As recommended by van Boven et al 15 in their cost-effectiveness analysis, close monitoring of inhalation technique and medication adherence should be considered before adding new inhaled medications to a therapeutic regimen that is already cumbersome for some patients with COPD. However, demonstration of proper inhaler technique by health-care providers may be as important as patients' ability to use these devices.…”