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van de Hei SJ, Kim CH, Honkoop PJ, Sont JK, Schermer TRJ, MacHale E, Costello RW, Kocks JWH, Postma MJ, van Boven JFM. Long-Term Cost-Effectiveness of Digital Inhaler Adherence Technologies in Difficult-to-Treat Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3064-3073.e15. [PMID: 37406806 DOI: 10.1016/j.jaip.2023.06.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Digital inhalers can monitor inhaler usage, support difficult-to-treat asthma management, and inform step-up treatment decisions yet their economic value is unknown, hampering wide-scale implementation. OBJECTIVE We aimed to assess the long-term cost-effectiveness of digital inhaler-based medication adherence management in difficult-to-treat asthma. METHODS A model-based cost-utility analysis was performed. The Markov model structure was determined by biological and clinical understanding of asthma and was further informed by guideline-based assessment of model development. Internal and external validation was performed using the Assessment of the Validation Status of Health-Economic (AdViSHE) tool. The INCA (Inhaler Compliance Assessment) Sun randomized clinical trial data were incorporated into the model to evaluate the cost-effectiveness of digital inhalers. Several long-term clinical case scenarios were assessed (reduced number of exacerbations, increased asthma control, introduction of biosimilars [25% price-cut on biologics]). RESULTS The long-term modelled cost-effectiveness based on a societal perspective indicated 1-year per-patient costs for digital inhalers and usual care (ie, regular inhalers) of €7,546 ($7,946) and €10,752 ($11,322), respectively, reflecting cost savings of €3,207 ($3,377) for digital inhalers. Using a 10-year intervention duration and time horizon resulted in cost savings of €26,309 ($27,703) for digital inhalers. In the first year, add-on biologic therapies accounted for 69% of the total costs in the usual care group and for 49% in the digital inhaler group. Scenario analyses indicated consistent cost savings ranging from €2,287 ($2,408) (introduction biosimilars) to €4,581 ($4,824) (increased control, decreased exacerbations). CONCLUSIONS In patients with difficult-to-treat asthma, digital inhaler-based interventions can be cost-saving in the long-term by optimizing medication adherence and inhaler technique and reducing add-on biologic prescriptions.
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Affiliation(s)
- Susanne J van de Hei
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; General Practitioners Research Institute, Groningen, The Netherlands
| | - Chong H Kim
- Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colo
| | - Persijn J Honkoop
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjard R J Schermer
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands; Science Support Office, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Elaine MacHale
- Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | - Janwillem W H Kocks
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; General Practitioners Research Institute, Groningen, The Netherlands; Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands; Observational and Pragmatic Research Institute, Singapore
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Center of Excellence for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia; Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands; Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Mtibaa M, Gupta S, Muthukumar M, Marvel J, Kaur H, Ishikawa R, Olivenstein R. Cost-Effectiveness of Once-Daily, Single-Inhaler Indacaterol Acetate/ Glycopyrronium Bromide/ Mometasone Furoate in Patients with Uncontrolled Moderate-to-Severe Asthma in Canada. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:957-967. [PMID: 34887668 PMCID: PMC8650773 DOI: 10.2147/ceor.s336915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose We evaluated the cost-effectiveness of high-dose indacaterol acetate (IND)/glycopyrronium bromide (GLY)/mometasone furoate (MF) (150/50/160 μg, once daily) compared with high-dose salmeterol/fluticasone (SAL/FLU; 50/500 µg, twice daily)+tiotropium (TIO; 5 µg, once daily) (SAL/FLU+TIO) and with high-dose SAL/FLU (50/500 µg, twice daily) for the treatment of inadequately controlled moderate-to-severe asthma. Patients and Methods A Markov model estimated the incremental cost-effectiveness ratio of treatment with high-dose IND/GLY/MF compared with SAL/FLU+TIO and high-dose IND/GLY/MF compared with SAL/FLU. The model included three health states (day-to-day symptoms without exacerbations, day-to-day symptoms with exacerbations, and death) with a 4-week cycle length. A lifetime time horizon was used. Exacerbation rates and utility values were derived from ARGON and IRIDIUM clinical trials. Canadian dollars (CAD$, 2020) were applied. Results IND/GLY/MF was the less costly and more effective treatment strategy compared with SAL/FLU+TIO and SAL/FLU in the base-case analyses. IND/GLY/MF had lower costs (CAD $33,501 versus CAD $50,907) and higher quality-adjusted life-years (QALYs) (18.37 versus 18.06 QALYs) compared with SAL/FLU+TIO. Compared with SAL/FLU, IND/GLY/MF had lower costs (CAD $33,408 versus CAD $36,577) and higher QALYs (19.33 versus 19.04 QALYs). IND/GLY/MF was the most cost-effective option in all scenarios tested. Conclusion IND/GLY/MF was cost-effective at a willingness-to-pay threshold of CAD $50,000/QALY in patients with uncontrolled, moderate-to-severe asthma versus SAL/FLU+TIO and SAL/FLU in the base case and all scenarios tested.
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Affiliation(s)
- Mondher Mtibaa
- Novartis Pharmaceuticals Canada Inc., Dorval, Quebec, Canada
| | | | | | | | - Harneet Kaur
- Novartis Healthcare Private Limited, Hyderabad, India
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Adibi A, Turvey SE, Lee TY, Sears MR, Becker AB, Mandhane PJ, Moraes TJ, Subbarao P, Sadatsafavi M. Development of a conceptual model of childhood asthma to inform asthma prevention policies. BMJ Open Respir Res 2021; 8:8/1/e000881. [PMID: 34740941 PMCID: PMC8573659 DOI: 10.1136/bmjresp-2021-000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background There is no definitive cure for asthma, as prevention remains a major goal. Decision analytic models are routinely used to evaluate the value-for-money proposition of interventions. Following best practice standards in decision-analytic modelling, the objective of this study was to solicit expert opinion to develop a concept map for a policy model for primary prevention of asthma. Methods We reviewed currently available decision analytic models for asthma prevention. A steering committee of economic modellers, allergists and respirologists was then convened to draft a conceptual model of paediatric asthma. A modified Delphi method was followed to define the context of the problem at hand (evaluation of asthma prevention strategies) and develop the concept map of the model. Results Consensus was achieved after three rounds of discussions, followed by concealed voting. In the final conceptual model, asthma diagnosis was based on three domains of lung function, atopy and their symptoms. The panel recommended several markers for each domain. These domains were in turn affected by several risk factors. The panel clustered all risk factors under three groups of ‘patient characteristic’, ‘family history’ and ‘environmental factors’. To be capable of modelling the interplay among risk factors, the panel recommended the use of microsimulation, with an open-population approach that would enable modelling phased implementation and gradual and incomplete uptake of the intervention. Conclusions Economic evaluation of childhood interventions for preventing asthma will require modelling of several codependent risk factors and multiple domains that affect the diagnosis. The conceptual model can inform the development and validation of a policy model for childhood asthma prevention.
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Affiliation(s)
- Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart E Turvey
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
| | - Tae Yoon Lee
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Malcolm R Sears
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Allen B Becker
- Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush J Mandhane
- Faculty of Medicine & Dentistry, Pediatrics Department, University of Alberta, Edmonton, Alberta, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
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Parra‐Padilla D, Zakzuk J, Carrasquilla M, Alvis‐Guzmán N, Dennis R, Rojas MX, Rondón M, Pérez A, Peñaranda A, Barragán AM, Caraballo L, García E. Cost-effectiveness of the subcutaneous house dust mite allergen immunotherapy plus pharmacotherapy for allergic asthma: A mathematical model. Allergy 2021; 76:2229-2233. [PMID: 33377199 DOI: 10.1111/all.14723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Devian Parra‐Padilla
- Health Economics Research Group University of Cartagena Cartagena Colombia
- ALZAK Foundation Cartagena Colombia
| | - Josefina Zakzuk
- Health Economics Research Group University of Cartagena Cartagena Colombia
- ALZAK Foundation Cartagena Colombia
- Institute for Immunological Research University of Cartagena Cartagena Colombia
| | - María Carrasquilla
- Health Economics Research Group University of Cartagena Cartagena Colombia
- ALZAK Foundation Cartagena Colombia
| | - Nelson Alvis‐Guzmán
- Health Economics Research Group University of Cartagena Cartagena Colombia
- ALZAK Foundation Cartagena Colombia
| | - Rodolfo Dennis
- Department of Research Fundación Cardioinfantil Bogotá Colombia
- School of Medicine and Health Sciences Universidad del Rosario Bogotá Colombia
| | - María X. Rojas
- Department of Research Fundación Cardioinfantil Bogotá Colombia
| | - Martín Rondón
- Department of Clinical Epidemiology and Biostatistics Pontificia Universidad Javeriana Bogotá Colombia
| | - Adriana Pérez
- Department of Biostatistics and Data Science School of Public Health The University of Texas Health Science Center at Houston‐UTHealth Austin TX USA
| | - Augusto Peñaranda
- Department of Otolaryngology Fundación Santa Fe de Bogotá Bogotá Colombia
- School of Medicine Universidad de los Andes Bogotá Colombia
| | - Ana M. Barragán
- Public Health Research Group School of Medicine Universidad del Rosario Bogotá Colombia
| | - Luis Caraballo
- Institute for Immunological Research University of Cartagena Cartagena Colombia
| | - Elizabeth García
- School of Medicine Universidad de los Andes Bogotá Colombia
- Department Pediatric Allergology Fundación Santa Fe de Bogotá Bogotá Colombia
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Jin H, Robinson S, Shang W, Achilla E, Aceituno D, Byford S. Overview and Use of Tools for Selecting Modelling Techniques in Health Economic Studies. PHARMACOECONOMICS 2021; 39:757-770. [PMID: 34013440 DOI: 10.1007/s40273-021-01038-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
The availability and use of tools to guide the choice of modelling technique are not well understood. Our study aims to review existing tools and explore the use of those tools in health economic models. Two reviews and one case study were conducted. Review 1 aimed to identify tools based on expert opinion and citation searching and explore the value of the tools for health economic models. Review 2, based on citation searching, aimed to describe how those tools have been used in health economic models. Both reviews were conducted using Web of Science and Scopus. Two independent reviewers selected studies for inclusion. A case study, focused on economic evaluations of antipsychotic medication in schizophrenia, was conducted to compare the modelling techniques used by existing models with modelling techniques recommended by identified tools. Seven tools were identified, of which the revised Brennan's toolkit, was assessed to be the most appropriate for health economic models. The seven tools were cited 126 times in publications reporting health economic models. Only 17 of these (13.5%) reported that they used the tool(s) to guide the choice of modelling technique. Application of these tools suggested discrete event simulation is most appropriate for modelling antipsychotic medication in schizophrenia, but discrete event simulation was only used by 17% of existing models. There is considerable inconsistency between the modelling techniques used by existing models and modelling techniques recommended by tools. It is recommended that for future modelling studies the choice of modelling technique should be justified, this can be achieved by the application of model selection tools, such as the revised Brennan's toolkit. Future research is required to explore the barriers to using model selection tools in health economic models and to update existing tools and make them easier to use.
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Affiliation(s)
- Huajie Jin
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience at King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK.
| | - Stewart Robinson
- School of Business and Economics, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Wenru Shang
- School of Public Health, Fudan University, No. 130, Dongan Road, Shanghai, 200032, People's Republic of China
| | | | - David Aceituno
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience at King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience at King's College London, The David Goldberg Centre, Box 024, London, SE5 8AF, UK
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Cividini S, Sinha I, Donegan S, Maden M, Culeddu G, Rose K, Fulton O, Hughes DA, Turner S, Tudur Smith C. EstablishINg the best STEp-up treatments for children with uncontrolled asthma despite INhaled corticosteroids (EINSTEIN): protocol for a systematic review, network meta-analysis and cost-effectiveness analysis using individual participant data (IPD). BMJ Open 2021; 11:e040528. [PMID: 33550231 PMCID: PMC7925932 DOI: 10.1136/bmjopen-2020-040528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Asthma affects millions of children worldwide-1.1 million children in the UK. Asthma symptoms cannot be cured but can be controlled with low-dose inhaled corticosteroids (ICSs) in the majority of individuals. Treatment with a low-dose ICS, however, fails to control asthma symptoms in around 10%-15% of children and this places the individual at increased risk for an asthma attack. At present, there is no clear preferred treatment option for a child whose asthma is not controlled by low-dose ICS and international guidelines currently recommend at least three treatment options. Herein, we propose a systematic review and individual participant data network meta-analysis (IPD-NMA) aiming to synthesise all available published and unpublished evidence from randomised controlled trials (RCTs) to establish the clinical effectiveness of pharmacological treatments in children and adolescents with uncontrolled asthma on ICS and help to make evidence-informed treatment choices. This will be used to parameterise a Markov-based economic model to assess the cost-effectiveness of alternative treatment options in order to inform decisions in the context of drug formularies and clinical guidelines. METHODS AND ANALYSIS We will search in MEDLINE, the Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, NICE Technology Appraisals and the National Institute for Health Research (NIHR) Health Technology Assessment series for RCTs of interventions in patients with uncontrolled asthma on ICS. All studies where children and adolescents were eligible for inclusion will be considered, and authors or sponsors will be contacted to request IPD on patients aged <18. The reference lists of existing clinical guidelines, along with included studies and relevant reviews, will be checked to identify further relevant studies. Unpublished studies will be located by searching across a range of clinical trial registries, including internal trial registers for pharmaceutical companies. All studies will be appraised for inclusion against predefined inclusion and exclusion criteria by two independent reviewers with disagreements resolved through discussion with a third reviewer. We will perform an IPD-NMA-eventually supplemented with aggregate data for the RCTs without IPD-to establish both the probability that a treatment is best and the probability that a particular treatment is most likely to be effective for a specific profile of the patient. The IPD-NMA will be performed for each outcome variable within a Bayesian framework, using the WinBUGS software. Also, potential patient-level characteristics that may modify treatment effects will be explored, which represents one of the strengths of this study. ETHICS AND DISSEMINATION The Committee on Research Ethics, University of Liverpool, has confirmed that ethics review is not required. The dissemination plan consists of publishing the results in an open-access medical journal, a plain-language summary available for parents and children, dissemination via local, national and international meetings and conferences and the press offices of our Higher Education Institutions (HEIs). A synopsis of results will be disseminated to NICE and British Thoracic Society/Scottish Intercollegiate Guidelines Network (SIGN) as highly relevant to future clinical guideline updates. PROSPERO REGISTRATION NUMBER CRD42019127599.
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Affiliation(s)
- Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Ian Sinha
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | - Sarah Donegan
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group (LRIG), University of Liverpool, Liverpool, UK
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Katie Rose
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Stephen Turner
- Department of Child Health, University Court of the University of Aberdeen, Aberdeen, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
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