Abstract | BACKGROUND: Digital inhalers can monitor inhaler usage, support difficult-to-treat asthma management, and inform step-up treatment decisions yet their economic value is unknown, hampering wide-scale implementation. OBJECTIVE: We aimed to assess the long-term cost-effectiveness of digital inhaler-based medication adherence management in difficult-to-treat asthma. METHODS: A model-based cost-utility analysis was performed. The Markov model structure was determined by biological and clinical understanding of asthma and was further informed by guideline-based assessment of model development. Internal and external validation was performed using the Assessment of the Validation Status of Health-Economic (AdViSHE) tool. The INCA ( Inhaler Compliance Assessment) Sun randomized clinical trial data were incorporated into the model to evaluate the cost-effectiveness of digital inhalers. Several long-term clinical case scenarios were assessed (reduced number of exacerbations, increased asthma control, introduction of biosimilars [25% price-cut on biologics]). RESULTS: The long-term modelled cost-effectiveness based on a societal perspective indicated 1-year per-patient costs for digital inhalers and usual care (ie, regular inhalers) of €7,546 ($7,946) and €10,752 ($11,322), respectively, reflecting cost savings of €3,207 ($3,377) for digital inhalers. Using a 10-year intervention duration and time horizon resulted in cost savings of €26,309 ($27,703) for digital inhalers. In the first year, add-on biologic therapies accounted for 69% of the total costs in the usual care group and for 49% in the digital inhaler group. Scenario analyses indicated consistent cost savings ranging from €2,287 ($2,408) (introduction biosimilars) to €4,581 ($4,824) (increased control, decreased exacerbations). CONCLUSIONS: In patients with difficult-to-treat asthma, digital inhaler-based interventions can be cost-saving in the long-term by optimizing medication adherence and inhaler technique and reducing add-on biologic prescriptions.
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Authors | Susanne J van de Hei, Chong H Kim, Persijn J Honkoop, Jacob K Sont, Tjard R J Schermer, Elaine MacHale, Richard W Costello, Janwillem W H Kocks, Maarten J Postma, Job F M van Boven |
Journal | The journal of allergy and clinical immunology. In practice
(J Allergy Clin Immunol Pract)
Vol. 11
Issue 10
Pg. 3064-3073.e15
(10 2023)
ISSN: 2213-2201 [Electronic] United States |
PMID | 37406806
(Publication Type: Randomized Controlled Trial, Journal Article)
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Copyright | Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Biosimilar Pharmaceuticals
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Topics |
- Humans
- Biosimilar Pharmaceuticals
(therapeutic use)
- Cost-Benefit Analysis
- Asthma
(drug therapy)
- Nebulizers and Vaporizers
- Administration, Inhalation
- Medication Adherence
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