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J Allergy Clin Immunol Pract. 2019 Mar;7(3):934-942. doi: 10.1016/j.jaip.2018.09.027. Epub 2018 Oct 5.

Does Changing Inhaler Device Impact Real-Life Asthma Outcomes? Clinical and Economic Evaluation.

Author information

1
Division of Pulmonary, Allergy and Critical Care Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
2
Department of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
3
Observational and Pragmatic Research Institute, Singapore.
4
Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyun Kwan University School of Medicine, Seoul, Korea.
5
Division of Pulmonary and Critical Care Medicine, Seoul National University, SMG-SNU Boramae Medical Center, Seoul, Korea.
6
Allergy and Clinical Immunology Department, Ajou University Medical Center, Seoul, Korea.
7
Division of Pulmonary and Allergy, Department of Internal Medicine, School of Medicine, Konkuk University, Seoul, Korea. Electronic address: khyou@kuh.ac.kr.
8
Observational and Pragmatic Research Institute, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.

Abstract

BACKGROUND:

Inhaler usability and deposition differ between devices. Change of device may therefore have an impact on clinical and economic outcomes.

OBJECTIVE:

To characterize clinical and economic asthma outcomes surrounding the change from a dry powder inhaler (DPI) to a pressurized metered-dose inhaler (pMDI) for fixed-dose combination inhaled corticosteroid/long-acting β agonist (FDC ICS/LABA) treatment.

METHODS:

Three retrospective cohort substudies using 2010 to 2015 data from the Korean Health Insurance and Review Assessment Service database were performed. Patients with asthma who received an FDC ICS/LABA pMDI for the first time after initially being on FDC ICS/LABA DPI were included. The following outcomes were assessed: (1) persistence of change to pMDI over 6 months, (2) clinical outcomes during the year after the change compared with the baseline year; and (3) noninferiority comparison of costs and effectiveness between patients changing to a pMDI and matched patients who continued their DPI.

RESULTS:

Patients who change inhalers seem to represent a more severe subpopulation. Fifty-eight percent of patients (95% CI, 56-60) persisted with the change. After the change in therapy, an increased proportion of patients (58.3%) remained free from severe exacerbations compared with the year before (47.4%; P < .001). Patients who changed to pMDIs had significantly less severe exacerbations, acute respiratory events, and lower short-acting β agonist inhaler average daily dose, but higher average ICS daily dose (all P < .05), compared with matched patients remaining on a DPI. Total costs were similar between patients who changed to pMDI therapy compared with those remaining on a DPI.

CONCLUSION:

Changing from a DPI to a pMDI for FDC ICS/LABA asthma treatment can be as effective and cost-effective as remaining on a DPI.

KEYWORDS:

Asthma; Cost-effectiveness; Dry powder inhaler; Economic evaluation; Inhaler; Pressurized metered-dose inhaler

PMID:
30292924
DOI:
10.1016/j.jaip.2018.09.027

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