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- W2766823926 abstract "Up to 70–80% of patients use their inhalers incorrectly (GINA 2017). Approximately 40% of the GINA-defined Step-3+ UK population inhale ICS/LABA through dry-powder inhalers (DPIs). DPIs require forceful inhalation for optimal drug delivery. The CRITIKAL study (Price et al. 2017) found a statistically significant association between ‘insufficient inspiratory effort’ and increased risk of uncontrolled asthma and exacerbations requiring hospitalisation. A cost-utility analysis was developed to explore the societal and economic impact of an ICS/LABA breath-triggered aerosol inhaler which does not require forceful inhalation for actuation, compared with DPIs budesonide/formoterol and fluticasone/salmeterol. A Markov model simulated patients switching between controlled and uncontrolled health states over one-year; each associated with different utility values (GOAL study, Briggs et al. 2006). The analysis assumed all inhalers had the same drug efficacy. The CRITIKAL study provided the relative risk of a patient having uncontrolled asthma and making an ‘insufficient inspiratory effort’ error – these data were applied to the transition probabilities. All other DPI-related errors assessed were not statistically significantly associated with asthma control. The analysis assumed the breath-triggered device lacked this critical handling error and had the same price as each comparator. Indirect costs were explored. Base-case analysis included direct costs: emergency room visits (£138), physician visits (£36) and hospitalisation/day (£401.63). The breath-triggered device dominated both budesonide/formoterol and fluticasone/salmeterol over one-year and resulted in direct cost savings of £98 and £142 with 0.0117 and 0.0169 additional QALYs, respectively. The breath-triggered device had the highest probability (100%) of being cost-effective at a £20,000/QALY threshold. One-way sensitivity analyses showed that the key factor driving variance was the relative risk of patients moving to an uncontrolled state for each comparator. The analysis demonstrated the economic and societal costs of ‘insufficient inspiratory effort’ and the potential benefit of introducing an effective intervention to eliminate this error." @default.
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- W2766823926 date "2017-10-01" @default.
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- W2766823926 title "Cost-Utility Analysis of A Novel Breath-Triggered Aerosol Inhaler Which Has Been Designed To Reduce The Critical Handling Error of Insufficient Inspiratory Effort" @default.
- W2766823926 doi "https://doi.org/10.1016/j.jval.2017.08.1064" @default.
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