Personalising adherence-enhancing interventions using a smart inhaler in patients with COPD: an exploratory cost-effectiveness analysis.
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ABSTRACT:
SUBMITTER: van Boven JFM
PROVIDER: S-EPMC6021429 | biostudies-literature | 2018 Jun
REPOSITORIES: biostudies-literature
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Personalising adherence-enhancing interventions using a smart inhaler in patients with COPD: an exploratory cost-effectiveness analysis.
van Boven Job F M JFM Cushen Breda B Sulaiman Imran I Greene Garrett G MacHale Elaine E Mokoka Matshediso C MC Doyle Frank F Reilly Richard B RB Bennett Kathleen K Costello Richard W RW
NPJ primary care respiratory medicine 20180627 1
Four inhaler adherence clusters have been identified using the INCA audio device in COPD patients: (1) regular use/good technique, (2) regular use/frequent technique errors, (3) irregular use/good technique, and (4) irregular use/frequent technique errors. Their relationship with healthcare utilization and mortality was established, but the cost-effectiveness of adherence-enhancing interventions is unknown. In this exploratory study, we aimed to estimate the potential cost-effectiveness of reach ...[more]
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Project description:ObjectiveTo evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients.Data sources/study settingCost-effectiveness analysis.Study designWe developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained.Data collection/extraction methodsModel inputs were extracted from published literature.Principal findingsCompared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month.ConclusionsMailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence.
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