The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries

Abstract

BackgroundAsthma and chronic obstructive pulmonary disease (COPD) are common chronic inflammatory respiratory diseases, which impose a substantial burden on healthcare systems and society. Fixed-dose combinations (FDCs) of inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA), often administered using dry powder inhalers (DPIs), are frequently prescribed to control persistent asthma and COPD. Use of DPIs has been associated with poor inhalation technique, which can lead to increased healthcare resource use and costs.MethodsA model was developed to estimate the healthcare resource use and costs associated with asthma and COPD management in people using commonly prescribed DPIs (budesonide + formoterol Turbuhaler® or fluticasone + salmeterol Accuhaler®) over 1 year in Spain, Sweden and the United Kingdom (UK). The model considered direct costs (inhaler acquisition costs and scheduled and unscheduled healthcare costs), indirect costs (productive days lost), and estimated the contribution of poor inhalation technique to the burden of illness.ResultsThe direct cost burden of managing asthma and COPD for people using budesonide + formoterol Turbuhaler® or fluticasone + salmeterol Accuhaler® in 2015 was estimated at €813 million, €560 million, and €774 million for Spain, Sweden and the UK, respectively. Poor inhalation technique comprised 2.2–7.7 % of direct costs, totalling €105 million across the three countries. When lost productivity costs were included, total expenditure increased to €1.4 billion, €1.7 billion and €3.3 billion in Spain, Sweden and the UK, respectively, with €782 million attributable to poor inhalation technique across the three countries. Sensitivity analyses showed that the model results were most sensitive to changes in the proportion of patients prescribed ICS and LABA FDCs, and least sensitive to differences in the number of antimicrobials and oral corticosteroids prescribed.ConclusionsThe cost of managing asthma and COPD using commonly prescribed DPIs is considerable. A substantial, and avoidable, contributor to this burden is poor inhalation technique. Measures that can improve inhalation technique with current DPIs, such as easier-to-use inhalers or better patient training, could offer benefits to patients and healthcare providers through improving disease outcomes and lowering costs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1482-7) contains supplementary material, which is available to authorized users.

Real‐life effectiveness of inhaler device switch from dry powder inhalers to pressurized metred‐dose inhalers in patients with asthma treated with ICS/LABA

“…Classic randomized control trials investigating the efficacy of inhaler devices tend to enrol very selective groups of patients . In real‐life practice setting, factors such as imperfect inhalation techniques and non‐adherence to treatment are common, negatively impacting inhaler treatment outcomes . The current study indicated that within Korean real‐life practice setting, pMDI was comparable to DPI in preventing asthma exacerbations, and led to better asthma control, despite the potential for imperfect adherence and inhaler technique.…”

“…11,17,18 In real-life practice setting, factors such as imperfect inhalation techniques and non-adherence to treatment are common, [18][19][20][21][22] × strength Categorized as 0, >0 to ≤250, >250 to ≤500, >500 μg daily ICS dosage (low, medium and high as per GINA guidelines) Oral thrush Diagnostic code for oral thrush OR Prescription of antifungal therapy negatively impacting inhaler treatment outcomes. 17,[22][23][24][25] The current study indicated that within Korean real-life practice setting, pMDI was comparable to DPI in preventing asthma exacerbations, and led to better asthma control, despite the potential for imperfect adherence and inhaler technique. In addition, while this study was retrospective in nature, data were collected prospectively and thus the patients were not influenced by recall bias.…”

Checking Inhaler Technique in the Community Pharmacy: Predictors of Critical Errors

“…Furthermore, inhaler technique errors have been associated with uncontrolled asthma as well as increased rates of severe COPD exacerbations [5][6][7]. Ultimately, poor inhalation technique leads to increased healthcare utilization and costs [8,9].…”

Dry Powder Inhalers—Between the Doctor and the Patient

“…Lewis et al [33,34] analysed the group of patients who were using inhaled glucocorticosteroids (GCS) and long-acting beta-2 agonists (LABA) with the popular DPI: Turbuhaler ® (budesonide + formoterol) or with Accuhaler ® (Disc) (fluticasone propionate + salmeterol) for one year in several European countries. The study published in the year 2016 supplied many practical conclusions [33]. Firstly, it was showed that the inappropriate technique of inhalation with the DPI significantly increases the risk of hospitalisation, visits to the emergency room, antibiotic therapy or the use of oral GCS (by 47%, 62%, 50% and 54% respectively) ( Table 2).…”