Does Changing Inhaler Device Impact Real-Life Asthma Outcomes?

Clinical and Economic Evaluation

Chin Kook Rhee, Job F M van Boven, Simon Wan Yau Ming, Hye Yun Park, Deog Kyeom Kim, Hae-Sim Park, Joanna Ling Zhi Jie, Kwang-Ha Yoo (Corresponding Author), David B Price

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Inhaler usability and deposition differ between devices. Change of device may therefore have an impact on clinical and economic outcomes.

OBJECTIVE: To characterize clinical and economic asthma outcomes surrounding the change from a dry powder inhaler (DPI) to a pressurized metered-dose inhaler (pMDI) for fixed-dose combination inhaled corticosteroid/long-acting β agonist (FDC ICS/LABA) treatment.

METHODS: Three retrospective cohort substudies using 2010 to 2015 data from the Korean Health Insurance and Review Assessment Service database were performed. Patients with asthma who received an FDC ICS/LABA pMDI for the first time after initially being on FDC ICS/LABA DPI were included. The following outcomes were assessed: (1) persistence of change to pMDI over 6 months, (2) clinical outcomes during the year after the change compared with the baseline year; and (3) noninferiority comparison of costs and effectiveness between patients changing to a pMDI and matched patients who continued their DPI.

RESULTS: Patients who change inhalers seem to represent a more severe subpopulation. Fifty-eight percent of patients (95% CI, 56-60) persisted with the change. After the change in therapy, an increased proportion of patients (58.3%) remained free from severe exacerbations compared with the year before (47.4%; P < .001). Patients who changed to pMDIs had significantly less severe exacerbations, acute respiratory events, and lower short-acting β agonist inhaler average daily dose, but higher average ICS daily dose (all P < .05), compared with matched patients remaining on a DPI. Total costs were similar between patients who changed to pMDI therapy compared with those remaining on a DPI.

CONCLUSION: Changing from a DPI to a pMDI for FDC ICS/LABA asthma treatment can be as effective and cost-effective as remaining on a DPI.

Original languageEnglish
Pages (from-to)934-942
Number of pages9
JournalThe journal of allergy and clinical immunology. In practice
Volume7
Issue number3
Early online date5 Oct 2018
DOIs
Publication statusPublished - 31 Mar 2019

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Nebulizers and Vaporizers
Dry Powder Inhalers
Cost-Benefit Analysis
Metered Dose Inhalers
Asthma
Equipment and Supplies
Economics
Costs and Cost Analysis
Therapeutics
Health Insurance
Adrenal Cortex Hormones
Databases

Keywords

  • asthma
  • inhaler
  • dry powder inhaler
  • pressurized metered-dose inhaler
  • cost-effectiveness
  • Dry powder inhaler
  • Economic evaluation
  • Inhaler
  • Pressurized metered-dose inhaler
  • Cost-effectiveness
  • Asthma
  • CARE
  • OBSTRUCTIVE PULMONARY-DISEASE
  • THERAPY
  • SELECTION
  • ASSOCIATION
  • BURDEN

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Does Changing Inhaler Device Impact Real-Life Asthma Outcomes? Clinical and Economic Evaluation. / Rhee, Chin Kook; van Boven, Job F M; Yau Ming, Simon Wan; Park, Hye Yun; Kim, Deog Kyeom; Park, Hae-Sim; Zhi Jie, Joanna Ling; Yoo, Kwang-Ha (Corresponding Author); Price, David B.

In: The journal of allergy and clinical immunology. In practice, Vol. 7, No. 3, 31.03.2019, p. 934-942.

Research output: Contribution to journalArticle

Rhee, Chin Kook ; van Boven, Job F M ; Yau Ming, Simon Wan ; Park, Hye Yun ; Kim, Deog Kyeom ; Park, Hae-Sim ; Zhi Jie, Joanna Ling ; Yoo, Kwang-Ha ; Price, David B. / Does Changing Inhaler Device Impact Real-Life Asthma Outcomes? Clinical and Economic Evaluation. In: The journal of allergy and clinical immunology. In practice. 2019 ; Vol. 7, No. 3. pp. 934-942.
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AU - Kim, Deog Kyeom

AU - Park, Hae-Sim

AU - Zhi Jie, Joanna Ling

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AU - Price, David B

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N2 - BACKGROUND: Inhaler usability and deposition differ between devices. Change of device may therefore have an impact on clinical and economic outcomes.OBJECTIVE: To characterize clinical and economic asthma outcomes surrounding the change from a dry powder inhaler (DPI) to a pressurized metered-dose inhaler (pMDI) for fixed-dose combination inhaled corticosteroid/long-acting β agonist (FDC ICS/LABA) treatment.METHODS: Three retrospective cohort substudies using 2010 to 2015 data from the Korean Health Insurance and Review Assessment Service database were performed. Patients with asthma who received an FDC ICS/LABA pMDI for the first time after initially being on FDC ICS/LABA DPI were included. The following outcomes were assessed: (1) persistence of change to pMDI over 6 months, (2) clinical outcomes during the year after the change compared with the baseline year; and (3) noninferiority comparison of costs and effectiveness between patients changing to a pMDI and matched patients who continued their DPI.RESULTS: Patients who change inhalers seem to represent a more severe subpopulation. Fifty-eight percent of patients (95% CI, 56-60) persisted with the change. After the change in therapy, an increased proportion of patients (58.3%) remained free from severe exacerbations compared with the year before (47.4%; P < .001). Patients who changed to pMDIs had significantly less severe exacerbations, acute respiratory events, and lower short-acting β agonist inhaler average daily dose, but higher average ICS daily dose (all P < .05), compared with matched patients remaining on a DPI. Total costs were similar between patients who changed to pMDI therapy compared with those remaining on a DPI.CONCLUSION: Changing from a DPI to a pMDI for FDC ICS/LABA asthma treatment can be as effective and cost-effective as remaining on a DPI.

AB - BACKGROUND: Inhaler usability and deposition differ between devices. Change of device may therefore have an impact on clinical and economic outcomes.OBJECTIVE: To characterize clinical and economic asthma outcomes surrounding the change from a dry powder inhaler (DPI) to a pressurized metered-dose inhaler (pMDI) for fixed-dose combination inhaled corticosteroid/long-acting β agonist (FDC ICS/LABA) treatment.METHODS: Three retrospective cohort substudies using 2010 to 2015 data from the Korean Health Insurance and Review Assessment Service database were performed. Patients with asthma who received an FDC ICS/LABA pMDI for the first time after initially being on FDC ICS/LABA DPI were included. The following outcomes were assessed: (1) persistence of change to pMDI over 6 months, (2) clinical outcomes during the year after the change compared with the baseline year; and (3) noninferiority comparison of costs and effectiveness between patients changing to a pMDI and matched patients who continued their DPI.RESULTS: Patients who change inhalers seem to represent a more severe subpopulation. Fifty-eight percent of patients (95% CI, 56-60) persisted with the change. After the change in therapy, an increased proportion of patients (58.3%) remained free from severe exacerbations compared with the year before (47.4%; P < .001). Patients who changed to pMDIs had significantly less severe exacerbations, acute respiratory events, and lower short-acting β agonist inhaler average daily dose, but higher average ICS daily dose (all P < .05), compared with matched patients remaining on a DPI. Total costs were similar between patients who changed to pMDI therapy compared with those remaining on a DPI.CONCLUSION: Changing from a DPI to a pMDI for FDC ICS/LABA asthma treatment can be as effective and cost-effective as remaining on a DPI.

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KW - Asthma

KW - CARE

KW - OBSTRUCTIVE PULMONARY-DISEASE

KW - THERAPY

KW - SELECTION

KW - ASSOCIATION

KW - BURDEN

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