An Early Health Economic Analysis of the Potential Cost Effectiveness of an Adherence Intervention to Improve Outcomes for Patients with Cystic Fibrosis

Abstract

Background: Cystic fibrosis (CF) negatively impacts upon health-related quality of life (HRQoL) and survival. Adherence to nebulised treatments is low; improving adherence is hypothesised to reduce rates of exacerbation requiring intravenous antibiotics and lung function decline. Results: If effective, the adherence intervention is expected to produce an additional 0.19 QALYs and cost savings of £64,078 per patient. Across all analyses, the intervention dominated current care. Over a 5-year period, the intervention is expected to generate cost savings of £49.5million for the estimated 2,979 CF patients with Pseudomonas aeruginosa currently aged 16 or above in the UK. If applied to a broader population of adult CF patients receiving any nebulised therapy, the expected savings could be considerably greater. Methods Conclusions:If effective, the adherence intervention is expected to produce additional health gains at a lower cost than current CF care. The economic analysis should however be revisited upon completion of the full RCT. More generally, the analysis suggests that considerable gains could be accrued through the implementation of adherence interventions which shift care from expensive hospital-based rescue to community-based prevention.

Health economic modelling in Cystic Fibrosis: A systematic review

“…of which one was a Health Technology Assessment (HTA) report (49). Two studies evaluated the impact of better drug adherence (44) or an adherence intervention (45) an inhalation device with adherence measurement compared to current CF care (45).…”

“…Studies selected for review utilised patient data from randomised controlled trials (RCTs). One study utilised the U.K. CF Trust registry for their patient data (45). In one study, the effectiveness data utilised to populate the model was based on premature infants with chronic lung disease being treated with Palivizumab (PMB) (46).…”

“…The populations included in the models include both adults and children (44,45,48,50,51), children (46) and adults (49) alone.…”

“…The health economic models were based within three countries, Canada (46), UK (45,(49)(50)(51)(52) and United States (U.S.) (44,47,48). The modelling adopted an NHS (45,49,50,52), US payer (44, 47), Canadian Healthcare (46), third party payer (48) and regional health authority (U.K.) perspective (51).…”

“…Although a majority of the studies were cost-utility analyses, all but two articles (45,49) provide outcomes beyond the QALYs and ICERs. Additional outcome measures provided include survival (44), different aspects of costs (44), life years gained (46-48, 51, 52) reduction in hospitalisation (48), lifetime cost (47), probability of lung transplantation (47) and budget impact analyses (46,47).…”