CHANGES IN FRACTIONAL NITRIC OXIDE CONCENTRATION IN EXHALED BREATH WITH THE USE OF ICS/LABA INHALERS

Abstract

Background and Aims: Real-world patients' medication adherence and inhalation techniques severely impact asthma clinical and economic outcomes, but have not been incorporated into previous asthma costeffectiveness models. Advancements in smart, digital and eHealth-based inhalers development could offer new opportunities. This study aims to develop a model incorporating adherence and inhalation technique and determine the potential cost-effectiveness of adherence and inhalation technique enhancing interventions. Methods: A Markov model with 6 health-states which consists of combinations of 2 asthma control status (controlled vs uncontrolled) along with 2 mortality states (asthma-related vs other cause) and exacerbation states (i.e. oral-corticosteroid burst, emergency department visit, and hospitalization) was developed for simulating the cost-effectiveness of adherence and inhalation improvement programs for patients with uncontrolled asthma. Bi-weekly health state transitions were used along with a lifetime horizon to determine the incremental cost-effectiveness ratio of three hypothetical scenarios (1. full adherence/good technique 2. full adherence/poor technique and 3. poor adherence/good technique) vs usual care (poor adherence/poor technique) within the U.S. payer perspective. Results: Over a 60-year period, the full adherence and good technique group was associated with (discounted) $107, 309 costs and 18.82 quality-adjusted life years (QALYs), the full adherence and poor technique group was associated with $107,936 costs and 18.80 QALYs, the poor adherence and good technique group was associated with $106,517 costs and 18.74 QALYs, and the poor adherence and technique group was associated with $103,667 costs and 18.74 QALYs. The incremental cost-effectiveness ratio of the full adherence good technique (full adherence poor technique and poor adherence good technique) vs usual care was $41,831 ($66,826 and $1,056,016) per QALY. Conclusion: Given the growing development of adherence and inhalation technique improving interventions (e.g. smart inhalers) in asthma, this study shows that attempts in improving adherence and inhalation technique for uncontrolled asthma patients can be associated with significant gains in QALYs at the standard willingness-to-pay threshold.