Cost-effectiveness of the Aerobika* oscillating positive expiratory pressure device in the management of COPD exacerbations
Authors Khoudigian-Sinani S, Kowal S, Suggett JA, Coppolo DP
Received 6 June 2017
Accepted for publication 25 August 2017
Published 19 October 2017 Volume 2017:12 Pages 3065—3073
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Shoghag Khoudigian-Sinani,1,2 Stacey Kowal,3 Jason A Suggett,4 Dominic P Coppolo5
1Faculty of Health Sciences, Department of Health Research, Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; 2QuintilesIMS, Toronto, ON, Canada; 3QuintilesIMS, Seattle, WA, USA; 4Trudell Medical International, London, ON, Canada; 5Monaghan Medical Corporation, Syracuse, NY, USA
Introduction: COPD places a huge clinical and economic burden on the US health care system, with acute exacerbations representing a key driver of direct medical costs. Current treatments, although effective in reducing symptoms and limiting exacerbations, do not adequately target the underlying disease processes that drive exacerbation development. The Aerobika* oscillating positive expiratory pressure (OPEP) device has been shown in a real-world effectiveness study to lower the frequency of moderate-to-severe exacerbations during a 30-day post-exacerbation period. This study sought to determine the impact on exacerbations and costs and to determine the cost-effectiveness of the Aerobika* device.
Methods: Data from published literature and national fee schedules were used to model the cost-effectiveness of the Aerobika* device in patients who had experienced an exacerbation in the previous month, or a post-exacerbation care population. Exacerbation trends and the impact of the Aerobika* device on reducing exacerbation frequency were modeled using a one-year Markov model with monthly cycles and three health states: (i) no exacerbation, (ii) exacerbation, and (iii) death. Scenario analysis and one-way sensitivity analysis (OWSA) were also performed.
Results: When the effect of Aerobika* device was assumed to last 30 days, use of the device resulted in cost-savings ($553 per patient) and improved outcomes (ie, six fewer exacerbations per 100 patients per year) compared to no OPEP/positive expiratory pressure therapy. When the effect of the Aerobika* device was assumed to extend beyond the conservative 30-day time frame, the Aerobika* device remained the dominant strategy (21 fewer exacerbations per 100 patients per year; cost savings of $1,952 per patient). Consistency in findings after performing OWSAs indicates the robustness of results.
Conclusion: The Aerobika* device is a cost-effective treatment option that provides clinical benefit and results in direct medical cost savings in a post-exacerbation care COPD population.
Keywords: COPD, exacerbations, cost-effectiveness, Aerobika* device
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