Lewis A, Torvinen S, Dekhuijzen P N R, Chrystyn H, Melani A, Zöllner Y, Kolbe K, Watson A T, Blackney M, Plich A
Covance Market Access, London, United Kingdom.
Market Access Department, Teva Pharmaceuticals Europe B.V., The Netherlands.
Respir Med. 2017 Aug;129:179-188. doi: 10.1016/j.rmed.2017.06.018. Epub 2017 Jun 27.
BACKGROUND: Fixed-dose combinations of inhaled corticosteroids and long-acting β agonists are commonly used for the treatment of asthma and COPD. However, the most frequently prescribed dry powder inhaler delivering this medicine - Symbicort (budesonide and formoterol, BF) Turbuhaler - is associated with poor inhalation technique, which can lead to poor disease control and high disease management costs. A recent study showed that patients make fewer inhaler errors when using the novel DuoResp (BF) Spiromax inhaler, compared with BF Turbuhaler. Therefore switching patients from BF Turbuhaler to BF Spiromax could improve inhalation technique, and potentially lead to better disease control and healthcare cost savings. METHODS: A model was developed to estimate the budget impact of reducing poor inhalation technique by switching asthma and COPD patients from BF Turbuhaler to BF Spiromax over three years in Germany, Italy, Sweden and the UK. The model estimated changes to the number, and associated cost, of unscheduled healthcare events. The model considered two scenarios: in Scenario 1, all patients were immediately switched from BF Turbuhaler to BF Spiromax; in Scenario 2, 4%, 8% and 12% of patients were switched in years 1, 2 and 3 of the model, respectively. RESULTS: In Scenario 1, per patient cost savings amounted to €60.10, €49.67, €94.14 and €38.20 in Germany, Italy, Sweden and the UK, respectively. Total cost savings in each country were €100.86 million, €19.42 million, €36.65 million and €15.44 million over three years, respectively, with an estimated 597,754, 151,480, 228,986 and 122,368 healthcare events avoided. In Scenario 2, cost savings totalled €8.07 million, €1.55 million, €2.93 million and €1.23 million over three years, respectively, with 47,850, 12,118, 18,319, and 9789 healthcare events avoided. Savings per patient were €4.81, €3.97, €7.53 and €3.06. CONCLUSIONS: We demonstrated that reductions in poor inhalation technique by switching patients from BF Turbuhaler to BF Spiromax are likely to improve patients' disease control and generate considerable cost savings through healthcare events avoided.
背景：吸入性糖皮质激素与长效β受体激动剂的固定剂量组合常用于治疗哮喘和慢性阻塞性肺疾病（COPD）。然而，最常处方的用于递送这种药物的干粉吸入器——信必可都保（布地奈德和福莫特罗，BF）——与吸入技术不佳有关，这可能导致疾病控制不佳和疾病管理成本高昂。最近一项研究表明，与信必可都保相比，患者使用新型都保（BF）思力华能倍乐吸入器时吸入错误更少。因此，将患者从信必可都保转换为思力华能倍乐可能会改善吸入技术，并有可能带来更好的疾病控制和医疗成本节约。 方法：建立了一个模型，以估计在德国、意大利、瑞典和英国，在三年时间里将哮喘和COPD患者从信必可都保转换为思力华能倍乐以减少不良吸入技术所产生的预算影响。该模型估计了非计划医疗事件的数量变化及相关成本。该模型考虑了两种情况：在情况1中，所有患者立即从信必可都保转换为思力华能倍乐；在情况2中，分别在模型的第1年、第2年和第3年将4%、8%和12%的患者进行转换。 结果：在情况1中，在德国、意大利、瑞典和英国，每位患者的成本节约分别为60.10欧元、49.67欧元、94.14欧元和38.20欧元。在每个国家，三年期间的总成本节约分别为1.0086亿欧元、1942万欧元、3665万欧元和1544万欧元，估计分别避免了597754、151480、228986和122368次医疗事件。在情况2中，三年期间的成本节约分别总计807万欧元、155万欧元、293万欧元和123万欧元，分别避免了47850、12118、18319和9789次医疗事件。每位患者的节约分别为4.81欧元、3.97欧元、7.53欧元和3.06欧元。 结论：我们证明，将患者从信必可都保转换为思力华能倍乐以减少不良吸入技术，可能会改善患者的疾病控制，并通过避免医疗事件产生可观的成本节约。
J Aerosol Med Pulm Drug Deliv. 2015-6
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