title: Estimating the economic consequences of an increased medication adherence due to a potential improvement in the inhaler technique with Spiromax®compared with Turbuhaler®in patients with moderate-to-severe chronic obstructive pulmonary disease in Spain.
abstract: OBJECTIVE
  The objective of this study was to estimate the economic impact of the introduction of DuoResp®Spiromax®, budesonide/formoterol fixed-dose combination (FDC), focusing on an increase in medication adherence due to an enhancement of the inhalation technique for the treatment of COPD patients in Spain and 5 regions including Andalusia, Catalonia, Galicia, Madrid, and Valencia.
  
  
  METHODS
  A 4-year budget impact model was developed for the time period of 2015-2018. This study aimed at evaluating the budget impact associated with the introduction of DuoResp Spiromax in comparison with Symbicort®Turbuhaler®and Rilast®Turbuhaler. National and regional data on COPD prevalence were obtained from the literature. Input data on health care resource utilization were obtained by clinical consultation. Resource included primary care visits, specialist visits, hospitalization, and emergency room visits as well as the length of hospital stay. Based on both pharmacological and health care resource costs, overall annual treatment cost per patient was estimated in EUR 2015.
  
  
  RESULTS
  It was calculated that 130,777 adults were treated with budesonide/formoterol FDC delivered by a dry powder inhaler, Turbuhaler, in Spain in 2015. However, the target population decreases over the next 4 years. This pattern was observed in 4 regions, but for Andalusia, the treated population increased slightly. The overall budget savings in Spain with the market share of DuoResp Spiromax were estimated to be €6.01 million for the time period of 2015-2018. Region-specific data resulted in savings of €902,133 in Andalusia, €740,520 in Catalonia, €464,281 in Galicia, €748,996 in Madrid, and €495,812 in Valencia for the time period of 2015-2018.
  
  
  CONCLUSIONS
  The introduction of budesonide/formoterol FDC delivered by Spiromax for COPD treatment is likely to contribute in a reduction of health care costs for Spain and in 5 Spanish regions. This model forecasts that Spain and these 5 Spanish regions were likely to have savings, which might be due to fewer days of hospitalization, avoided emergency room, and primary care visits.
authors.affiliation: Department of Economics, Universitat de Barcelona.
authors.forename: Josep
authors.initials: J
authors.lastname: Darbà
authors.affiliation: BCN Health Economics & Outcomes Research S.L., Barcelona.
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
authors.affiliation: Hospital General Universitario de Alicante, Alicante.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Pascual
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