Cost-Effectiveness of the Aerobika® Oscillating Positive Expiratory Pressure Device in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Canada

Nguyen Xuan Thanh, Philip Jacobs, Jason Suggett, Andrew McIvor, Alan Kaplan, Nguyen Xuan Thanh, Philip Jacobs, Jason Suggett, Andrew McIvor, Alan Kaplan

Abstract

Background: The Aerobika® oscillating positive expiratory pressure (OPEP) device is a hand-held, drug-free medical device that has been shown to improve lung function and improve health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). We estimated the cost-effectiveness of this device among postexacerbation COPD patients in the Canadian healthcare system.

Methods: We performed a cost-utility analysis using a Markov model to compare both costs and outcome of patients with COPD who had recently experienced an exacerbation between 2 treatment arms: patients who used the Aerobika® device and patients who did not use the Aerobika® device. This cost-utility analysis included costs based on the Alberta healthcare system perspective as these represent Canadian experience. A one-year horizon with 12 monthly cycles was used.

Results: For a patient after 1 year, the use of the Aerobika® device would save $694 in healthcare costs and produce 0.04 more in quality-adjusted life years (QALYs) in comparison with no positive expiratory pressure (PEP)/OPEP therapy. In other words, the economic outcome of the device was dominant (i.e., more effective and less costly). The probability for this device to be the dominant strategy was 72%. With a willingness to pay (WTP) threshold of $50,000 per QALY gained, the probability for the Aerobika® device to be cost-effective was 77%.

Conclusions: Given one of the major treatment goals in the GOLD guidelines is to minimize the negative impact of exacerbations and prevent re-exacerbations, the Aerobika® OPEP device should be viewed as a potential component of a treatment strategy to improve symptom control and reduce the risk of re-exacerbations in patients with COPD.

Figures

Figure 1
Figure 1
Model structure.
Figure 2
Figure 2
(a) Tornado diagram for incremental cost of Aerobika® OPEP device vs. no PEP/OPEP device. (b) Tornado diagram for incremental effect (QALY) of Aerobika® OPEP device vs. no PEP/OPEP device. Note. C1: cost per severe exacerbation, C2: cost per patient per month if no exacerbation, C3: cost per moderate exacerbation, P1: percentage of severe exacerbation if no Aerobika® device, P2: percentage of severe exacerbation if using Aerobika® device, P3: probability of exacerbation in the first month after exacerbation if no Aerobika® device, P4: probability of exacerbation between the 2nd and 12th months after exacerbation if no Aerobika® device, P5: probability of death among COPD patients with a severe exacerbation, P6: probability of death among patients with COPD (per year), RR1: relative risk of exacerbation in the first month between Aerobika® device and control groups, RR2: relative risk of exacerbation in the 2nd and 12th months between Aerobika® device and control groups, U1: utility score of patients with COPD (on average), U2: utility decrement for severe exacerbation (per month), U3: utility decrement for moderate exacerbation (per month).
Figure 3
Figure 3
Incremental cost-effectiveness scatterplot.

References

    1. Dhamane A., Moretz C., Zhou Y., et al. COPD exacerbation frequency and its association with health care resource utilization and costs. International Journal of Chronic Obstructive Pulmonary Disease. 2015;10:2609–2618. doi: 10.2147/copd.s90148.
    1. Shah T., Press V. G., Huisingh-Scheetz M., White S. R. COPD readmissions. Chest. 2016;150(4):916–926. doi: 10.1016/j.chest.2016.05.002.
    1. Jencks S. F., Williams M. V., Coleman E. A. Rehospitalizations among patients in the medicare fee-for-service program. New England Journal of Medicine. 2009;360(14):1418–1428. doi: 10.1056/nejmsa0803563.
    1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018. .
    1. Burgel P. R., Martin C. Mucus hypersecretion in COPD: should we only rely on symptoms? European Respiratory Review. 2010;19(116):94–96. doi: 10.1183/09059180.00004410.
    1. Svenningsen S., Paulin G. A., Sheikh K., et al. Oscillatory positive expiratory pressure in chronic obstructive pulmonary disease. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2016;13(1):66–74. doi: 10.3109/15412555.2015.1043523.
    1. Burudpakdee C., Seetasith A., Dunne P., et al. A real-world study of 30-day exacerbation outcomes in chronic obstructive pulmonary disease (COPD) patients managed with Aerobika OPEP. Pulmonary Therapy. 2017;3:163–171. doi: 10.1007/s41030-017-0027-5.
    1. Khoudigian-Sinani S., Kowal S., Suggett J. A., Coppolo D. P. Cost-effectiveness of the Aerobika∗ oscillating positive expiratory pressure device in the management of COPD exacerbations. International Journal of COPD. 2017;12:3065–3073. doi: 10.2147/copd.s143334.
    1. Drummond M. F., Schulper M. J., Claxton K., Stoddart G. L., Torrance G. W. Methods for the Economic Evaluation of Health Care Programmes. 4th. Oxford, UK: Oxford University Press; 2015.
    1. Sonnenberg F. A., Beck J. R. Markov models in medical decision making: a practical guide. Medical Decision Making. 1993;13(4):322–339. doi: 10.1177/0272989x9301300409.
    1. Celli B. R. Predictors of mortality in COPD. Respiratory Medicine. 2010;104(6):773–779. doi: 10.1016/j.rmed.2009.12.017.
    1. Connors A. F., Jr, Dawson N. V., Thomas C., et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (study to understand prognoses and preferences for outcomes and risks of treatment) American Journal of Respiratory and Critical Care Medicine. 1996;154(4):959–967. doi: 10.1164/ajrccm.154.4.8887592.
    1. Anthonisen N. R., Skeans M. A., Wise R. A., Manfreda J., Kanner R. E., Connett J. E. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142(4):233–239. doi: 10.7326/0003-4819-142-4-200502150-00005.
    1. Sin D. D., Wu L., Anderson J. A., et al. Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease. Thorax. 2005;60(12):992–997. doi: 10.1136/thx.2005.045385.
    1. Hoogendoorn M., Feenstra T. L., Schermer T. R., Hesselink A. E., Rutten-van Mölken M. P. Severity distribution of chronic obstructive pulmonary disease (COPD) in Dutch general practice. Respiratory Medicine. 2006;100(1):83–86. doi: 10.1016/j.rmed.2005.04.004.
    1. Alberta Health. Interactive health data application. April 2018. .
    1. Data Obtained from Trudell Medical International.
    1. Rutten-van Mölken M. P., Hoogendoorn M., Lamers L. M. Holistic preferences for 1-year health profiles describing fluctuations in health: the case of chronic obstructive pulmonary disease. Pharmacoeconomics. 2009;27(6):465–477. doi: 10.2165/00019053-200927060-00003.
    1. Samyshkin Y., Schlunegger M., Haefliger S., Ledderhose S., Radford M. Cost-effectiveness of roflumilast in combination with bronchodilator therapies in patients with severe and very severe COPD in Switzerland. International Journal of Chronic Obstructive Pulmonary Disease. 2013;8:79–87. doi: 10.2147/copd.s37486.
    1. Briggs A., Claxton K., Sculpher M. Decision Modelling for Health Economic Evaluation. New York, NY, USA: Oxford University Press; 2006.
    1. Black W. C. The CE plane: a graphic representation of cost-effectiveness. Medical Decision Making. 1990;10(3):212–214. doi: 10.1177/0272989x9001000308.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa