PRS14 COST-EFECTIVENESS ANALYSIS OF AN INTERVENTION TO REDUCE THE CRITICAL HANDLING ERRORS OF FIXED-DOSE ICS/LABA COMBINATIONS IN ASTHMA PATIENTS IN SPAIN

Abstract

This study explores the cost-effectiveness of an error-targeted intervention, in asthma patients treated with fixed-dose inhaled corticosteroid/long-acting beta-2 agonist (ICS/LABA) devices, consisting in the use of the new breath-activated inhaler (K-Haler®) in comparison with the most used ICS/LABA combination devices: Fluticasone/Saltemerol pMDI (FS-MDI), Fluticasone/Salmeterol Accuhaler® (ACCU), Budesonide/Formoterol Turbuhaler® (TURBU). A probabilistic Markov cost-utility model was developed, based on the CRITIKAL study findings (Price et al. 2017). Patients with moderate-severe asthma, according to Global Initiative for Asthma (GINA) criteria, transitioned between controlled and uncontrolled health states, on weekly cycles over a 5-year period. Estimated asthma exacerbations were also included in the model. Spanish costs and resources were accounted, based on literature review and an expert panel opinion. Effectiveness outcome measure were Quality-Adjusted Life Years (QALYs). Model analysis was carried out, primary, from the perspective of the Spanish National Health System (SNHS) and, secondarily, from the societal perspective. A 3% discount rate, was reckoned, affecting costs (€2019) and effects. The intervention (K-Haler® device) dominated pMDI as well as the two DPI devices compared over 5 years. Direct cost savings of €207.44/€421.68/€957.12 vs FS-MDI, ACCU and TURBU respectively, alongside additional 0.03/0.05/0.02 QALY gains. Furthermore, it showed the highest probability of being cost-effective at a €30,000/QALY threshold. Key factors driving variance were weekly utilities per state and RR of moving to an uncontrolled state, and its impact on exacerbations. The robustness of the model was validated with both deterministic and probabilistic sensitivity analysis. Handling error minimization due to K-Haler® device utilization resulted in an improved asthma control, improving treatment effectiveness as quality of life of patients. K-Haler® is a dominant therapeutic alternative in comparison with the other inhaler devices analyzed from the SNHS perspective. Study funded by Mundipharma Pharmaceuticals, S.L.