Budesonide plus formoterol delivered via Spiromax® for the management of asthma and COPD: The potential impact on unscheduled healthcare costs of improving inhalation technique compared with Turbuhaler®

Background: Fixed-dose combinations of inhaled corticosteroids and long-acting p2 agonists are commonly used for the treatment of asthma and COPD. However, the most frequently prescribed dry powder inhaler delivering this medicine - Symbicort (R) (budesonide and formoterol, BF) Turbuhaler (R) - is associated with poor inhalation technique, which can lead to poor disease control and high disease management costs. A recent study showed that patients make fewer inhaler errors when using the novel DuoResp (R) (BF) Spiromax (R) inhaler, compared with BF Turbuhaler (R). Therefore switching patients from BF Turbuhaler (R) to BF Spiromax (R) could improve inhalation technique, and potentially lead to better disease control and healthcare cost savings. Methods: A model was developed to estimate the budget impact of reducing poor inhalation technique by switching asthma and COPD patients from BF Turbuhaler (R) to BF Spiromax (R) over three years in Germany, Italy, Sweden and the UK. The model estimated changes to the number, and associated cost, of unscheduled healthcare events. The model considered two scenarios: in Scenario 1, all patients were immediately switched from BF Turbuhaler (R) to BF Spiromax (R); in Scenario 2, 4%, 8% and 12% of patients were switched in years 1, 2 and 3 of the model, respectively. Results: In Scenario 1, per patient cost savings amounted to (sic)60.10, (sic)49.67, (sic)94.14 and (sic)38.20 in Germany, Italy, Sweden and the UK, respectively. Total cost savings in each country were 100.86 million, (sic)19.42 million, (sic)36.65 million and (sic)15.44 million over three years, respectively, with an estimated 597,754, 151,480, 228,986 and 122,368 healthcare events avoided. In Scenario 2, cost savings totalled (sic)8.07 million, (sic)1.55 million, (sic)2.93 million and (sic)1.23 million over three years, respectively, with 47,850, 12,118, 18,319, and 9789 healthcare events avoided. Savings per patient were (sic)4.81, (sic)3.97, (sic)7.53 and (sic)3.06. Conclusions: We demonstrated that reductions in poor inhalation technique by switching patients from BF Turbuhaler (R) to BF Spiromax (R) are likely to improve patients' disease control and generate considerable cost savings through healthcare events avoided. (C) 2017 The Authors. Published by Elsevier Ltd.