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01.12.2014 | Research | Ausgabe 1/2014 Open Access

Respiratory Research 1/2014

Improving inhaler adherence in patients with Chronic Obstructive Pulmonary Disease: a cost-effectiveness analysis

Respiratory Research > Ausgabe 1/2014
Job FM van Boven, Eline Tommelein, Koen Boussery, Els Mehuys, Stefan Vegter, Guy GO Brusselle, Maureen PMH Rutten-van Mölken, Maarten J Postma
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1465-9921-15-66) contains supplementary material, which is available to authorized users.

Competing interests

JB, ET, KB, EM, SV and GB declare that they have no competing interests, regarding the submitted work. MP reports grants, personal fees and non-financial support from various pharmaceutical companies, outside the submitted work. The Erasmus University, Institute for Medical Technology Assessment, where MR is employed, has received funding for designing and conducting cost-effectiveness studies of COPD drugs from multiple pharmaceutical companies (Boehringer Ingelheim, Nycomed, Pfizer). MR has received speaker fees and compensation for serving on advisory boards for GSK, Boehringer Ingelheim, Pfizer, Nycomed and Novartis. MR does not own stock of any pharmaceutical company.

Authors’ contributions

JB, SV, MR and MP designed the research. JB and SV performed the analyses. ET, KB, EM, MR and GB provided input for the analyses. All authors interpreted the data. JB and ET wrote the paper. All authors commented on the first draft. All authors read and approved the final version of the manuscript.



The PHARMACOP-intervention significantly improved medication adherence and inhalation technique for patients with COPD compared with usual care. This study aimed to evaluate its cost-effectiveness.


An economic analysis was performed from the Belgian healthcare payer’s perspective. A Markov model was constructed in which a representative group of patients with COPD (mean age of 70 years, 66% male, 43% current smokers and mean Forced Expiratory Volume in 1 second of % predicted of 50), was followed for either receiving the 3-month PHARMACOP-intervention or usual care. Three types of costs were calculated: intervention costs, medication costs and exacerbation costs. Outcome measures included the number of hospital-treated exacerbations, cost per prevented hospital-treated exacerbation and cost per Quality Adjusted Life-Year. Follow-up was 1 year in the basecase analysis. Sensitivity and scenario analyses (including long-term follow-up) were performed to assess uncertainty.


In the basecase analysis, the average overall costs per patient for the PHARMACOP-intervention and usual care were €2,221 and €2,448, respectively within the 1-year time horizon. This reflects cost savings of €227 for the PHARMACOP-intervention. The PHARMACOP-intervention resulted in the prevention of 0.07 hospital-treated exacerbations per patient (0.177 for PHARMACOP versus 0.244 for usual care). Results showed robust cost-savings in various sensitivity analyses.


Optimization of current pharmacotherapy (e.g. close monitoring of inhalation technique and medication adherence) has been shown to be cost-saving and should be considered before adding new therapies.
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