Back to Journals » ClinicoEconomics and Outcomes Research » Volume 2

Cost-effectiveness analysis of corticosteroid inhaler devices in primary care asthma management: A real world observational study

Authors Kemp L, Haughney J, Barnes N, Sims E, von Ziegenweidt J, Hillyer, Lee AJ, Chisholm A, Price DB

Published 1 July 2010 Volume 2010:2 Pages 75—85

DOI https://doi.org/10.2147/CEOR.S10835

Review by Single-blind

Peer reviewer comments 3

Linda Kemp1, John Haughney2, Neil Barnes3, Erika Sims1, Julie von Ziegenweidt1, Elizabeth V Hillyer1, Amanda J Lee4, Alison Chisholm1, David Price1,2

1Research in Real Life Ltd, Old Winery Business Park, Cawston, Norwich, UK; 2Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, UK; 3Department of Respiratory Medicine, London Chest Hospital, Bonner Road, London, UK; 4Medical Statistics Team, Section of Population Health, University of Aberdeen, Foresterhill, Aberdeen, UK

Purpose: To evaluate and compare real world cost-effectiveness of inhaled corticosteroids (ICS) administered by metered dose inhaler (MDI), breath-actuated MDI (BAI), or dry powder inhaler (DPI) in asthma.

Patients and methods: This retrospective database study analyzed the direct health care costs and proportion of patients (aged 5–60 years) achieving asthma control over 1 year in two population groups: those starting ICS (initiation population) and those receiving a first increase in ICS dose (step-up population). Asthma control was defined as no unplanned asthma visits, oral corticosteroids, or antibiotics for lower respiratory infection; outcomes were adjusted for confounding variables. Cost-effectiveness of BAI and DPI were compared with MDI.

Results: For the initiation population (n = 56,347), average annual health care costs per person (adjusted results), as compared with MDIs, were £9 higher (95% CI: -1.65 to 19.71) for BAIs and £32 higher (95% CI: 19.51 to 43.66) for DPIs. The probability of BAIs being the dominant strategy (more effective and less costly than MDIs) was 5% and of BAIs being more effective and more costly than MDIs was 94%. DPIs were consistently more effective and more costly than MDIs, with an incremental cost-effectiveness ratio of £1711 (95% CI: 760 to 3,576) per additional controlled patient per year. For the step-up population (n = 9169), mean total health care costs per person, (adjusted) as compared with MDIs, were £1 higher (95% CI: -27.28 to 31.55) for BAIs and £73 higher (95% CI: 44.48 to 103.29) for DPIs. The probability of BAIs being dominant was 48% and of BAIs being more effective but more costly than MDIs was 52%; the probability of DPIs being more effective but more costly than MDIs was 96%.

Conclusion: The real world effectiveness of ICS inhalers may vary, and inhaler device selection for patients with asthma should take into consideration not only initial device cost but also the subsequent health care resource costs.

Keywords: asthma control, breath-actuated inhaler, dry powder inhaler, metered dose inhaler, incremental cost-effectiveness ratio

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 

 

Other articles by this author:

Seasonal patterns of oral antihistamine and intranasal corticosteroid purchases from Australian community pharmacies: a retrospective observational study

Carney AS, Price DB, Smith PK, Harvey R, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner DA, Carter V, Durieux AMS

Pragmatic and Observational Research 2017, 8:157-165

Published Date: 30 August 2017

Asthma referrals: a key component of asthma management that needs to be addressed

Price D, Bjermer L, Bergin DA, Martinez R

Journal of Asthma and Allergy 2017, 10:209-223

Published Date: 25 July 2017

Cardiovascular risks in smokers treated with nicotine replacement therapy: a historical cohort study

Dollerup J, Vestbo J, Murray-Thomas T, Kaplan A, Martin RJ, Pizzichini E, Pizzichini MMM, Burden A, Martin J, Price DB

Clinical Epidemiology 2017, 9:231-243

Published Date: 26 April 2017

Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study

Voorham J, Vrijens B, van Boven JFM, Ryan D, Miravitlles M, Law LM, Price DB

Pragmatic and Observational Research 2017, 8:31-41

Published Date: 18 April 2017

An evaluation of exact matching and propensity score methods as applied in a comparative effectiveness study of inhaled corticosteroids in asthma

Burden A, Roche N, Miglio C, Hillyer EV, Postma DS, Herings RMC, Overbeek JA, Khalid JM, van Eickels D, Price DB

Pragmatic and Observational Research 2017, 8:15-30

Published Date: 22 March 2017

The use of multiple respiratory inhalers requiring different inhalation techniques has an adverse effect on COPD outcomes

Bosnic-Anticevich S, Chrystyn H, Costello RW, Dolovich MB, Fletcher MJ, Lavorini F, Rodríguez-Roisin R, Ryan D, Wan Yau Ming S, Price DB

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:59-71

Published Date: 21 December 2016

Predicting frequent COPD exacerbations using primary care data

Kerkhof M, Freeman D, Jones R, Chisholm A, Price DB

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2439-2450

Published Date: 9 November 2015

The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK

Brusselle G, Price D, Gruffydd-Jones K, Miravitlles M, Keininger DL, Stewart R, Baldwin M, Jones RC

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2207-2217

Published Date: 15 October 2015

Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD

Postma DS, Roche N, Colice G, Israel E, Martin RJ, van Aalderen WMC, Grigg J, Burden A, Hillyer EV, von Ziegenweidt J, Gopalan G, Price D

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:1163-1186

Published Date: 17 October 2014

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

Price D, West D, Brusselle G, Gruffydd-Jones K, Jones R, Miravitlles M, Rossi A, Hutton C, Ashton VL, Stewart R, Bichel K

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:889-905

Published Date: 27 August 2014

Impact of night-time symptoms in COPD: a real-world study in five European countries

Price D, Small M, Milligan G, Higgins V, Garcia Gil E, Estruch J

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:595-603

Published Date: 27 November 2013

Readers of this article also read:

Emerging and future therapies for hemophilia

Carr ME, Tortella BJ

Journal of Blood Medicine 2015, 6:245-255

Published Date: 3 September 2015

Green synthesis of water-soluble nontoxic polymeric nanocomposites containing silver nanoparticles

Prozorova GF, Pozdnyakov AS, Kuznetsova NP, Korzhova SA, Emel’yanov AI, Ermakova TG, Fadeeva TV, Sosedova LM

International Journal of Nanomedicine 2014, 9:1883-1889

Published Date: 16 April 2014

Methacrylic-based nanogels for the pH-sensitive delivery of 5-Fluorouracil in the colon

Ashwanikumar N, Kumar NA, Nair SA, Kumar GS

International Journal of Nanomedicine 2012, 7:5769-5779

Published Date: 15 November 2012

A novel preparation method for silicone oil nanoemulsions and its application for coating hair with silicone

Hu Z, Liao M, Chen Y, Cai Y, Meng L, Liu Y, Lv N, Liu Z, Yuan W

International Journal of Nanomedicine 2012, 7:5719-5724

Published Date: 12 November 2012

Cross-linked acrylic hydrogel for the controlled delivery of hydrophobic drugs in cancer therapy

Deepa G, Thulasidasan AK, Anto RJ, Pillai JJ, Kumar GS

International Journal of Nanomedicine 2012, 7:4077-4088

Published Date: 27 July 2012

Crystallization after intravitreal ganciclovir injection

Pitipol Choopong, Nattaporn Tesavibul, Nattawut Rodanant

Clinical Ophthalmology 2010, 4:709-711

Published Date: 14 July 2010