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

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.

Keywords:

• asthma control
• breath-actuated inhaler
• dry powder inhaler
• metered dose inhaler
• incremental cost-effectiveness ratio

Acknowledgements

Access to data from the General Practice Research Database was funded by Merck and Co., Inc., and the analysis was funded by Teva Pharmaceuticals Ltd.

Disclosures

Linda Kemp has no conflict of interest to declare. John Haughney has received some or all of the following: reimbursements for attending symposia; fees for speaking and organizing educational events; funds for research; fees for consulting; from the following pharmaceutical companies:

AstraZeneca, Boehringer-Ingelheim, Glaxo Smith Kline, Merck, Sharp and Dohme, Mundipharma, Novartis, Nycomed, Sanofi Aventis and Teva. He holds no stocks or shares. He has no relationship with the tobacco industry.

Professor Neil Barnes has lectured for and has received consulting fees from AstraZeneca, GlaxoSmithKline, Chiesi, Cipla, Nycomed, Novartis, NAPP.

Professor Barnes has had research grants from Astra-Zeneca, GlaxoSmithKline and Novartis which have gone into departmental funds. Erika Sims has worked on projects funded by Schering Plough, Merck & Co., Inc., and Teva, and has received funding to attend conferences. Julie von Ziegenweidt has no conflict of interest to declare.

Elizabeth V. Hillyer has done freelance writing work for Merck & Co., Inc., Aerocrine, and Teva Santé. Amanda J. Lee receives payment for statistical consultancy through the independent research company, Thorpe Respiratory Research. Alison Chisholm has no conflict of interest to declare David Price has consultant arrangements with Aerocrine, Boehringer Ingelheim, Dey Pharmaceuticals, GlaxoSmithKline, Merck, Sharpe and Dohme, Novartis, Schering-Plough, and Teva. He or his team have received grants and research support for research in respiratory disease from the following organizations: UK National Health Service, Aerocrine, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck, Sharpe and Dohme, Novartis, Pfizer, Schering Plough, and Teva. He has spoken for: Boehringer Ingelheim, GlaxoSmithKline, Merck, Sharpe and Dohme, Pfizer, and Teva.