Economic Evaluation of Tobramycin Inhalation Powder for the Treatment of Chronic Pulmonary Pseudomonas aeruginosa Infection in Patients with Cystic Fibrosis

Abstract

BackgroundChronic lung infection with Pseudomonas aeruginosa occurs in approximately 50% of patients with cystic fibrosis (CF). This infection further compromises lung function, and significantly contributes to the increased healthcare costs.ObjectivesInhaled tobramycin, used to manage P. aeruginosa infection in CF patients, is available as powder (tobramycin inhalation powder, TIP) and solution (tobramycin inhalation solution, TIS). Evidence suggests increased adherence with the use of TIP over TIS. Hence, this analysis aimed to evaluate the potential pharmacoeconomic benefit of increased adherence with TIP over TIS in the US setting.MethodsA patient-level simulation model was developed to compare TIP with TIS. Both costs and benefits were predicted over a 10-year time horizon from a payer’s perspective, and were discounted annually at 3%. All costs were presented in 2016 US dollars.ResultsTIP was associated with greater quality-adjusted life-years (by 0.27) and lower total costs (by US$36,168) as compared with TIS over a 10-year time horizon. TIP-treated patients experienced a decreased mean number of exacerbations than TIS-treated patients (39.24 vs 50.20). Furthermore, administration of TIP via the T-326 Inhaler was associated with significant cost savings per patient, because of the nebulizer required for administering TIS (by US$1596) and exacerbation costs (by US$76,531). Probabilistic sensitivity analysis showed that TIP was dominant over TIS in 100% of the simulations.ConclusionTIP is likely to be a more cost-effective treatment than TIS, and therefore may reduce the economic burden of CF.

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).…”

“…no treatment (46,51). Two studies utilised individual patient simulation models (44,50) to evaluate the impact of Tobramycin inhalation nebuliser (TIS) vs. Tobramycin inhalation powder (TIP) and Ivacaftor in CF individuals, respectively. Two studies evaluated the impact of Ivacaftor and usual care alone to only usual care (47,50), which consisted of CF-related medication, devices and respiratory therapy (50).…”

“…Two studies evaluated the impact of Ivacaftor and usual care alone to only usual care (47,50), which consisted of CF-related medication, devices and respiratory therapy (50). Two articles evaluated the impact of dry inhalation to nebulisation for antibiotics (44,49), although one looked at the impact of adherence (44) and the other at different antibiotic treatments (49). One additional study evaluated the impact of inhalation of two different types of antibiotics (48).…”

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

“…Cost-utility analysis (CUA) in which the quality-adjusted life year (QALY) is the measure of outcome was the most common type of economic evaluation undertaken. Costeffectiveness analysis (CEA) was the second most common evaluation method utilised but was conducted in conjunction to cost-utility analysis in three studies (44,46,47).…”