Background
The burden of asthma and chronic obstructive pulmonary disease (COPD) in Europe
Treatment of asthma and COPD
Poor inhalation technique
Methods
Model design
Parameters
Model population
Parameter | Spain | Sweden | UK |
---|---|---|---|
Prevalence | |||
Total number of individuals aged ≥18 (n) | 37,860,506 [36] | 7,772,932 [37] | 50,909,098 [38] |
Prevalence of diagnosed asthma (%) | 3.5 [39] | 8.0 [41] | 6.1 [42] |
Prevalence of diagnosed COPD (%) | 2.8 [40] | 7.0 [43] | 1.8 [42] |
Proportion of patients receiving ICS + LABA FDCs (%) | |||
Asthma | 33.4 [39] | 50.0 [41] | 35.5 [44] |
COPD | 33.7 [40] | 39.7 [43] | 35.5a
|
Proportion of patients using commonly prescribed DPIs to administer ICS + LABA FDCs (%) | |||
BF Turbuhaler®
| 34.6 [30] | 74.7 [59] | 31.1 [30] |
FS Accuhaler®
| 37.3 [30] | 15.1 [59] | 25.2 [30] |
Prescription distribution of BF Turbuhaler® doses (%) | |||
BF Turbuhaler® 80/4.5 μg | 3.4 [30] | 1.1 [30] | 8.6 [30] |
BF Turbuhaler® 160/4.5 μg | 54.0 [30] | 48.5 [30] | 55.9 [30] |
BF Turbuhaler® 320/9 μg | 42.7 [30] | 50.4 [30] | 35.5 [30] |
Prescription distribution of FS Accuhaler® doses (%) | |||
FS Accuhaler® 100 μg | 5.9 [30] | 3.8 [30] | 11.5 [30] |
FS Accuhaler® 250 μg | 40.1 [30] | 50.3 [30] | 25.5 [30] |
FS Accuhaler® 500 μg | 54.0 [30] | 45.9 [30] | 63.0 [30] |
Inhaler acquisition costs
Parameter | Spain (€) | Sweden (€) | UK (€) |
---|---|---|---|
BF Turbuhaler®
| |||
BF Turbuhaler® 80/4.5 μg | 32.92 [45] | 53.30 [30] | 45.60 [46] |
BF Turbuhaler® 160/4.5 μg | 41.46 [45] | 42.53 [30] | 52.65 [46] |
BF Turbuhaler® 320/9 μg | 41.46 [45] | 38.61 [30] | 52.65 [46] |
FS Accuhaler®
| |||
FS Accuhaler® 100 μg | 29.38 [45] | 25.84 [30] | 24.88 [47] |
FS Accuhaler® 250 μg | 35.50 [45] | 30.48 [30] | 48.51 [47] |
FS Accuhaler® 500 μg | 47.90 [45] | 40.12 [30] | 56.38 [47] |
Resource use and healthcare costs
Parameter | Spain | Sweden | UK | |||
---|---|---|---|---|---|---|
Frequency (n) | Cost per event (€)a
| Frequency (n) | Cost per event (€)a
| Frequency (n) | Cost per event (€)a
| |
Annual scheduled healthcare events per person | ||||||
Asthma | ||||||
Nurse visits | 0.76 [60] | 18.99 [61] | 0.68 [62] | 62.08 [63] | 31.35 [67] | |
GP visits | 2.30 [68] | 39.35 [61] | 0.68 [62] | 152.41 [63] | 75.51 [67] | |
Specialist visits | 2.21 [68] | 78.70 [60] | 0.34 [62] | 206.25 [63] | 0.15 [69]b
| 133.93 [67] |
COPD | ||||||
Nurse visits | 0.76 [60] | 18.99 [61] | 0.00c
| 0.00c
| 31.35 [67] | |
GP visits | 0.47 [68] | 39.35 [61] | 1.70 [70] | 152.41 [63] | 75.51 [67] | |
Specialist visits | 1.43 [68] | 78.70 [60] | 1.70 [70] | 206.25 [63] | 3.42 [71] | 133.93 [67] |
Annual unscheduled healthcare events per person | ||||||
Asthma | ||||||
Hospitalisations | 1,753.68 [74] | |||||
ED visits | 0.20 [75] | 177.67 [63] | 182.12 [74] | |||
Antimicrobial courses | 0.70 [76]e
| 4.76 [77] | 0.50f
| 1.07 [78] | 0.70 [76]e
| |
OCS courses | 0.63 [81] | 17.22 [77] | 0.20f
| 2.34 [78] | 0.14 [81] | 55.28 [82] |
COPD | ||||||
Hospitalisations | 3,554.73 [74] | |||||
ED visits | 0.31 [43] | 177.67 [63] | 182.12 [74] | |||
Antimicrobial courses | 0.38 [83] | 4.76 [77] | 2.00f
| 1.07 [78] | 1.51 [83] | |
OCS courses | 0.17 [83] | 17.22 [77] | 1.60f
| 2.34 [78] | 0.68 [83] | 55.28 [82] |
Annual productivity losses per person | ||||||
Productive days lost (asthma) | 62.04 [36] | 4.00 [62] | 205.50 [88] | 169.22 [91] | ||
Productive days lost (COPD) | 24.00g
| 62.04 [36] | 24.00g
| 205.50 [88] | 169.22 [91] |
Impact of poor inhalation technique
Unscheduled healthcare event | Increased riska
|
---|---|
Hospitalisation | 47 % |
ED visit | 62 % |
Course of antimicrobials | 50 % |
Course of OCS | 54 % |
Productive day lost | 47%b
|
Sensitivity analyses
-
Proportion of patients using ICS + LABA FDCs (±10 %) – variation accounts for changes in prescription habits
-
Number of doses per day – the upper (3) and lower (1) bounds reflect recommendations in the Summary of Product Characteristics (SmPCs) for each inhaler
-
Cost of hospitalisation (±20 %)
-
Cost of ED visits (±20 %)
-
Cost of additional courses of antimicrobials (±20 %)
-
Cost of additional courses of OCS (±20 %)
-
Proportion of patients with poor inhalation technique (±20 %)
Results
Number of events
Output | Spain | Sweden | UK |
---|---|---|---|
Population (adults receiving BF Turbuhaler® or FS Accuhaler®) | 572,317 | 473,022 | 803,821 |
Number of scheduled healthcare events | |||
Nurse visit | 434,961 | 189,795 | 719,878 |
GP visit | 854,662 | 519,445 | 610,497 |
Specialist visit | 1,068,044 | 424,548 | 721,953 |
Total | 2,357,668 | 1,133,788 | 2,052,328 |
Number of unscheduled healthcare events | |||
Hospitalisation | 92,676 | 106,546 | 33,851 |
ED visits | 101,035 | 115,077 | 33,715 |
Antimicrobial courses | 313,760 | 524,096 | 699,262 |
OCS courses | 239,520 | 363,655 | 207,711 |
Total | 746,991 | 1,109,374 | 974,539 |
Number of productive days lost | |||
Lost productivity | 9,895,128 | 5,736,196 | 14,712,035 |
Costs
Poor inhalation technique
Unscheduled healthcare events | Spain | Sweden | UK | |||
---|---|---|---|---|---|---|
Frequency (n; thousands) | Cost (€; millions) | Frequency (n; thousands) | Cost (€; millions) | Frequency (n; thousands) | Cost (€; millions) | |
Hospitalisations | ||||||
Total | 92.7 | 373.9 | 106.5 | 130.7 | 33.9 | 73.3 |
Not due to poor inhalation technique | 78.4 | 316.2 | 89.0 | 109.2 | 28.6 | 61.8 |
Due to poor inhalation techniquea
| 14.3 | 57.7 | 17.6 | 21.5 | 5.3 | 11.5 |
Contribution of poor inhalation techniqueb(%) | 15.4 | 16.5 | 15.6 | |||
ED visits | ||||||
Total | 101.0 | 18.4 | 115.1 | 20.4 | 33.7 | 6.1 |
Not due to poor inhalation technique | 81.4 | 14.8 | 91.3 | 16.2 | 27.1 | 4.9 |
Due to poor inhalation techniquea
| 19.6 | 3.6 | 23.8 | 4.2 | 6.6 | 1.2 |
Contribution of poor inhalation techniqueb(%) | 19.4 | 20.7 | 19.7 | |||
Antimicrobial courses | ||||||
Total | 313.8 | 1.5 | 524.1 | 0.6 | 699.3 | 14.3 |
Not due to poor inhalation technique | 262.7 | 1.3 | 433.2 | 0.5 | 584.0 | 12.0 |
Due to poor inhalation techniquea
| 51.0 | 0.2 | 90.9 | 0.1 | 115.3 | 2.4 |
Contribution of poor inhalation techniqueb(%) | 16.3 | 17.3 | 16.5 | |||
OCS courses | ||||||
Total | 239.5 | 4.1 | 363.7 | 0.9 | 207.7 | 11.5 |
Not due to poor inhalation technique | 198.0 | 3.4 | 296.4 | 0.7 | 171.2 | 9.5 |
Due to poor inhalation techniquea
| 41.5 | 0.7 | 67.2 | 0.2 | 36.5 | 2.0 |
Contribution of poor inhalation techniqueb(%) | 17.3 | 18.5 | 17.6 | |||
Productive days lost | ||||||
Total | 9,714.9 | 602.7 | 5,736.2 | 1,178.8 | 14,712.0 | 2,489.6 |
Not due to poor inhalation technique | 8,215.5 | 509.7 | 4,790.8 | 984.5 | 12,409.8 | 2,100.0 |
Due to poor inhalation techniquea
| 1,499.4 | 93.0 | 945.4 | 194.3 | 2,302.2 | 389.6 |
Contribution of poor inhalation techniqueb(%) | 15.4 | 16.5 | 15.6 | |||
Overall cost burden | ||||||
Total | 10,461.9 | 1,000.6 | 6,845.6 | 1,331.4 | 15,686.6 | 2,594.8 |
Not due to poor inhalation technique | 8,836.0 | 845.4 | 5,700.7 | 1,111.1 | 13,220.7 | 2,188.2 |
Due to poor inhalation techniquea
| 1,625.8 | 155.2 | 1,144.9 | 220.3 | 2,465.9 | 406.7 |