Cost-effectiveness analysis of corticosteroid inhaler devices in primary care asthma management

a real world observational study

Linda Kemp, John Haughney, Neil Barnes, Erika Sims, Julie von Ziegenweidt, Elizabeth V Hillyer, Amanda J Lee, Alison Chisholm, David Price

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)75-85
Number of pages11
JournalClinicoEconomics and Outcomes Research
Volume2
Publication statusPublished - 2010

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Nebulizers and Vaporizers
Cost-Benefit Analysis
Observational Studies
Primary Health Care
Adrenal Cortex Hormones
Metered Dose Inhalers
Asthma
Health Care Costs
Equipment and Supplies
Dry Powder Inhalers
Population
Health Resources
Population Groups
Respiratory Tract Infections
Patient Selection
Retrospective Studies
Observational study
Primary care
Cost-effectiveness analysis
Databases

Cite this

Cost-effectiveness analysis of corticosteroid inhaler devices in primary care asthma management : a real world observational study. / Kemp, Linda; Haughney, John; Barnes, Neil; Sims, Erika; von Ziegenweidt, Julie; Hillyer, Elizabeth V; Lee, Amanda J; Chisholm, Alison; Price, David.

In: ClinicoEconomics and Outcomes Research, Vol. 2, 2010, p. 75-85.

Research output: Contribution to journalArticle

Kemp, Linda ; Haughney, John ; Barnes, Neil ; Sims, Erika ; von Ziegenweidt, Julie ; Hillyer, Elizabeth V ; Lee, Amanda J ; Chisholm, Alison ; Price, David. / Cost-effectiveness analysis of corticosteroid inhaler devices in primary care asthma management : a real world observational study. In: ClinicoEconomics and Outcomes Research. 2010 ; Vol. 2. pp. 75-85.
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T1 - Cost-effectiveness analysis of corticosteroid inhaler devices in primary care asthma management

T2 - a real world observational study

AU - Kemp, Linda

AU - Haughney, John

AU - Barnes, Neil

AU - Sims, Erika

AU - von Ziegenweidt, Julie

AU - Hillyer, Elizabeth V

AU - Lee, Amanda J

AU - Chisholm, Alison

AU - Price, David

PY - 2010

Y1 - 2010

N2 - 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.

AB - 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.

M3 - Article

VL - 2

SP - 75

EP - 85

JO - ClinicoEconomics and Outcomes Research

JF - ClinicoEconomics and Outcomes Research

SN - 1178-6981

ER -