title: A budget impact analysis of Spiromax(®) compared with Turbuhaler(®) for the treatment of moderate to severe asthma: a potential improvement in the inhalation technique to strengthen medication adherence could represent savings for the Spanish Healthcare System and five Spanish regions.
abstract: OBJECTIVE
  To assess the economic impact of the introduction of DuoResp(®) Spiromax(®) by focusing on a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthmatics in Spain and five Spanish regions including Andalusia, Catalonia, Galicia, Madrid, and Valencia.
  
  
  METHODS
  A 4-year budget impact model was developed for the period 2015-2018 from the Spanish Healthcare System perspective. Budesonide-formoterol fixed-dose combination delivered by Turbuhaler(®) was considered to be the most appropriate comparator for assessing the budget impact with the introduction of DuoResp(®) Spiromax(®). National and regional data on asthma prevalence were obtained from the literature. Input parameters on health care resources were obtained by consulting experts from different Spanish hospitals. Resources used included medical visits, emergency room visits, and hospitalizations. The average numbers of primary care and specialist visits per year were also gathered. Based on health care resource use per patient, the total treatment cost per patient was estimated.
  
  
  RESULTS
  The population with moderate to severe asthma treated with budesonide-formoterol fixed-dose combinations delivered by Turbuhaler(®) in 2015 was estimated to be 166,985 in Spain. Region-specific prevalence data resulted in 25,081, 12,392, 16,097, 17,829, and 15,148 patients in Andalusia, Catalonia, Galicia, Madrid, and Valencia, respectively. Based on the forecast uptake of DuoResp(®) Spiromax(®), the total budget savings in Spain were expected to be €1.509 million over the next 4 years. Region-specific rates imply that the total savings were expected to be €229,706 in Andalusia, €90,145 in Catalonia, €188,327 in Galicia, €122,669 in Madrid, and €165,796 in Valencia over 2015-2018.
  
  
  CONCLUSIONS
  The introduction of DuoResp(®) Spiromax(®), which represents a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthma, could represent savings for the Spanish National Health Society and five Spanish regions.
authors.affiliation: Department of Economics, Universitat de Barcelona.
authors.forename: Josep
authors.initials: J
authors.lastname: Darbà
authors.affiliation: BCN Health Economics & Outcomes Research SL.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ramírez
authors.affiliation: Hospital Laredo, Cantabria.
authors.forename: Juan L
authors.initials: JL
authors.lastname: García-Rivero
authors.affiliation: Hospital Ramón y Cajal, Madrid.
authors.forename: Sagrario
authors.initials: S
authors.lastname: Mayoralas-Alises
authors.affiliation: Hospital General Universitario de Alicante, Alicante.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Pascual
authors.affiliation: Hospital Universitario Germans Trias i Pujol, Barcelona.
authors.forename: Albert
authors.initials: A
authors.lastname: Roger
authors.affiliation: Hospital de Alta Resolución el Toyo, Andalusia.
authors.forename: Diego
authors.initials: D
authors.lastname: Vargas
authors.affiliation: Market Access and HEOR Department, TEVA Pharmaceutical, Madrid, Spain.
authors.forename: Adi
authors.initials: A
authors.lastname: Bijedic
keywords: dry powder inhaler; economic evaluation; payers perspective; region-specific estimates