Cost-effectiveness of interventions to improve adherence and outcomes in asthma and COPD
Published: January 3, 2024
Poor adherence to inhaler therapy in asthma and COPD is associated with increased risk of negative clinical outcomes, including lower quality of life (QoL), increased healthcare resource utilization, and even death. It can also lead to unnecessary early escalation to costly biologics. Non-adherence can be erratic, intentional (or intelligent), and unwitting, potentially affected by several factors, such as symptom variability, comorbidities, patient’s concerns and disease awareness, inhaler choice, and education. As a result of this complex combination of factors, personalized interventions, including novel digital technologies, seem to be the way forward for improvement, yet an overview of the economic value underpinning these interventions was lacking.
A recent article by Job F.M. van Boven, PharmD, PhD, and colleagues, published in The Journal of Allergy and Clinical Immunology: In Practice, reported the findings of a systematic literature review (SLR) that examined the cost consequences, cost-effectiveness, and budget impact of interventions designed to improve adherence to asthma or COPD inhaled medication regimens. The SLR used Medline and PreMEDLINE (PubMed), Embase (Embase.com, Elsevier), and EconLit for publications between January 2000 and July 2021, as well as clinical trial databases and selected conference proceedings.
Twenty-six articles were included in the review, 11 reported a direct assessment of adherence, 15 included economic evaluations, and 17 described healthcare resource utilization (HCRU). Intervention types involved one or more of the following elements: smart devices or digital resources, telemedicine, clinic-based support, counseling, and inhaler technology. These were often found to be highly cost-effective, and reductions in direct costs and HCRU (health care visits, hospital admissions, and/or the use of medications, including add-on/reliever treatment and antibiotics) were frequently reported. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases in which favorable outcomes were observed. The review showed that interventions improving adherence to asthma or COPD medications are cost-effective and can reduce rates of HCRU associated with poorly controlled disease. Multidisciplinary care involving personalized advice and digitally enhanced communications appear to offer the greatest benefit.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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