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


International Journal of Chronic Obstructive Pulmonary Disease

Marc Miravitlles,1,2 Alicia Marín,2,3 Alicia Huerta,4 David Carcedo,5 Alba Villacampa,5 Jaume Puig-Junoy6

1Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut De Recerca (VHIR), Vall d’Hebron Hospital Campus, Barcelona, Spain; 2CIBER De Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 3Pneumology Department, Hospital Germans Trias I Pujol, Badalona, Spain; 4Market Access Department, GlaxoSmithKline SA, Madrid, Spain; 5Hygeia Consulting SL, Madrid, Spain; 6Barcelona School of Management, Universitat Pompeu Fabra (BSM-UPF), Barcelona, Spain

Correspondence: Marc Miravitlles
Pneumology Department, Hospital Universitari Vall d’Hebron, P. Vall d’Hebron 119-129, Barcelona 08035, Spain
Tel/ Fax +34 932746083

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.

Keywords: COPD, adherence, healthcare, economic evaluation

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