Chin Kook Rhee1, Job F M van Boven2, Simon Wan Yau Ming3, Hye Yun Park4, Deog Kyeom Kim5, Hae-Sim Park6, Joanna Zhi Jie Ling3, Kwang-Ha Yoo7, David B Price8. 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.
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/LABAasthma treatment can be as effective and cost-effective as remaining on a DPI.
Authors: Seong Dae Woo; Young Min Ye; Youngsoo Lee; So Hee Lee; Yoo Seob Shin; Joo Hun Park; Hyunna Choi; Hyun Young Lee; Hyun Jung Shin; Hae Sim Park Journal: Allergy Asthma Immunol Res Date: 2020-05 Impact factor: 5.764