Development, validation and application of an asthma cost-effectiveness model for value assessment of digital inhaler adherence enhancing strategies

Abstract

Background: Digital inhalers provide real-time feedback on inhaler usage and have shown to increase medication adherence and inform step-up treatment decisions. Yet, no model exists to evaluate the cost-effectiveness of digital inhalers. Aims and objectives: To develop a cost-effectiveness model to assess the value of digital medication adherence enhancing strategies in patients with asthma, to validate the model and to apply the model to assess the cost-effectiveness of digital inhalers. Methods: A new Markov model was developed. The model structure was determined by biological and clinical understanding of asthma and was further informed by expert consultation. Internal and external validation was performed according to the AdViSHE tool. The INCA Sun study data set was applied to evaluate cost-effectiveness of digital inhalers. Results: A cost-effectiveness analysis of the INCA Sun study from a societal perspective showed per-patient costs for digital inhalers and usual care of €7,546 and €10,752, respectively, over a 1-year time horizon, and €181,438 and €184,645, respectively, over a lifetime horizon, reflecting a cost saving of €3,207 for digital inhalers. Add-on biologic therapies accounted for 69% of the total costs in the usual care group and for 49% in the digital inhaler group in the first year. Conclusions: The developed model can predict the cost-effectiveness of digital medication adherence enhancing strategies in asthma. Furthermore, we found that the digital inhaler intervention used in the INCA Sun trial is cost-saving, by optimizing medication adherence and inhaler technique and avoiding biologic therapy prescriptions.

Authors 10

1. Susanne J. van de Hei

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Health Sciences, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, Netherlands

2. Chong Kim

   University of Colorado Denver

   Affiliation as printed

   Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, United States

3. Persijn Honkoop Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands

4. Jacob K. Sont Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands

5. Tjard R. Schermer

   Radboud University Medical Center

   Affiliation as printed

   Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands

6. Elaine MacHale

   Royal College of Surgeons in Ireland · Beaumont Hospital

   Affiliation as printed

   Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland

7. Richard W. Costello

   Royal College of Surgeons in Ireland · Beaumont Hospital

   Affiliation as printed

   Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland

8. Janwillem W.H. Kocks

   University Medical Center Groningen · University of Groningen · General Practitioners Research Institute

   Affiliation as printed

   General Practitioners Research Institute; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen; Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, Netherlands

   General Practitioners Research Institute

   Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen

   Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, Netherlands

9. Maarten Jacobus Postma

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

10. Job F. M. van Boven

    University Medical Center Groningen · University of Groningen

    Affiliation as printed

    Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen; Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, Netherlands

    Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen

    Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, Netherlands