title: Improving inhaler adherence in patients with chronic obstructive pulmonary disease: a cost-effectiveness analysis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. j.f.m.van.boven@rug.nl.
authors.forename: Job Fm
authors.initials: JF
authors.lastname: van Boven
authors.forename: Eline
authors.initials: E
authors.lastname: Tommelein
authors.forename: Koen
authors.initials: K
authors.lastname: Boussery
authors.forename: Els
authors.initials: E
authors.lastname: Mehuys
authors.forename: Stefan
authors.initials: S
authors.lastname: Vegter
authors.forename: Guy Go
authors.initials: GG
authors.lastname: Brusselle
authors.forename: Maureen Pmh
authors.initials: MP
authors.lastname: Rutten-van Mölken
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D003157:Community Pharmacy Services / Q000191:economics* / Q000592:standards; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009330:Nebulizers and Vaporizers / Q000191:economics* / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology