<p>Estimation of the Clinical and Economic Impact of an Improvement in Adherence Based on the Use of Once-Daily Single-Inhaler Triple Therapy in Patients with COPD</p>

Abstract

Background: Adherence to treatment is key to achieve desired outcomes. In COPD, adherence is generally suboptimal and is impaired by treatment complexity. Objective: To estimate the clinical and economic impact of an improvement in treatment adherence due to an increased use of once-daily single-inhaler triple therapy (SITT) in patients with COPD. Patients and Methods: A 7-state Markov model with monthly cycles was developed. Patients with moderate-to-very severe COPD, for whom triple therapy is indicated, were included. Outcomes and costs were estimated and compared for two scenarios: current distribution of adherent patients treated with multiple inhaler triple therapies (MITT) vs a potential scenario where patients shifted to once-daily SITT. In the potential scenario, adherence improvement due to once-daily SITT attributes was estimated. Costing was based on the Spanish National Health System (NHS) perspective (€2019). A 3-year time horizon was defined considering a 3% discount rate for both costs and outcomes. Results: A target population of 185,111 patients with moderate-to-very severe COPD currently treated with MITT was estimated. A 20% increase in the use of once-daily SITT in the potential scenario raised adherence up to 52%. This resulted in 6835 exacerbations and 532 deaths avoided, with 775 LYs and 594 QALYs gained. Total savings reached €7,082,105. Exacerbation reduction accounted for 61.8% (€4,378,201) of savings. Conclusion: Increasing the use of once-daily SITT in patients with moderate-to-very severe COPD treated with triple therapy would be associated with an improvement in adherence, a reduction of exacerbations and deaths, and cost savings for the Spanish NHS.

The Impact of Budesonide/Formoterol pMDI Medication Reminders on Adherence in Chronic Obstructive Pulmonary Disease (COPD) Patients: Results of a Randomized, Phase 4, Clinical Study

“…This is especially striking given that there were no daily incentives (eg, gamification, patient management education, or personalization of the reminders/how a patient’s disease status might be improved by enhanced adherence) for patients to use their medication as reminded. Notably, prior retrospective, interventional, and modeling studies have also demonstrated that improved adherence can yield net cost savings in COPD, even after accounting for increases in medication costs, 3 , 5 , 15 , 16 and that this may be achieved using straightforward measures such as consolidation of treatment to a once-daily single inhaler therapy 15 or by brief community pharmacist interventions. 16 Similarly, the findings of this present study underscore the potential for even a simple, basic reminder, made possible by smart technology in this case, to serve as a cost-effective tool for enhancing treatment adherence.…”

Single-inhaler triple vs single-inhaler dual therapy in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized control trials

“…Additionally, previous research has shown that COPD patients have a lower rate of adherence to treatment with multiple-inhaler therapy than single-inhaler therapy [ 32 , 33 ]. Single-inhaler therapy is simpler and thus may lead to better compliance and improved clinical outcomes in COPD patients [ 34 ] and therefore decrease healthcare resource utilization [ 7 , 35 ]. If these outcomes are achieved without increasing costs, this may reduce the economic and healthcare resource burden [ 6 ].…”

Single-inhaler Triple vs Single-inhaler Dual Therapy in Patients with Chronic Obstructive Pulmonary Disease: A Meta-analysis of Randomized Control Trials

“…[12] Also, previous research has shown that COPD patients have a lower adherence to treatment persistence with multiple inhaler therapy than single-inhaler therapy. [27] [28] Single-inhaler therapy is simpler, and thus may lead to better compliance and improve clinical outcomes for COPD patients [29] and therefore decrease healthcare resource utilization. [11] [15] If these outcomes are achieved without increasing costs, this may reduce economic and healthcare resource burden.…”