Clinical and economic impact of an improvement in adherence based on specific attributes of single-inhaler triple therapies in COPD patients

Objective: Adherence in COPD is generally suboptimal and is impaired by treatment complexity. This study aimed to estimate the clinical and economic impact of an improvement in adherence based on a reduction in treatment complexity, in COPD patients using single-inhaler triple therapies (SITT). Methods: A previously published 7-state Markov model with monthly cycles was used. Moderate-to-very severe COPD patients treated with multiple inhaler triple therapies (MITT) were included. Outcomes (exacerbations, life years [LYs], and quality-adjusted life years [QALYs]) and costs were estimated and compared for two scenarios: current distribution of adherent patients treated with MITT (49% adherent patients) vs a potential scenario where patients shifted to SITT. Initial distribution of patients, transition probabilities, utilities and the impact of SITT attributes (number of devices and dosing frequency) on adherence were obtained from literature. Costing was from the Spanish National Health System (NHS) perspective (€2018). A 3-year time horizon was defined considering a 3% discount rate for both costs and outcomes. Sensitivity analyses were performed to assess robustness of the results. Results: From epidemiological sources, it was estimated that 185,111 patients were on MITT in Spain. Figure 1 showed results according to % of shift to SITT. Conclusion: Reducing treatment complexity with the use of SITT would be associated with an improvement in adherence and a reduction of events and costs for the NHS.