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

Publication date: Available online 5 October 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Chin Kook Rhee, Job F.M. van Boven, Simon Wan Yau Ming, Hye Yun Park, Deog Kyeom Kim, Hae-Sim Park, Joanna Ling Zhi Jie, Kwang-Ha Yoo, David B. Price

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.