Cost-effectiveness of the Aerobika* oscillating positive expiratory pressure device in the management of COPD exacerbations


Abstract

Introduction: COPD places a huge clinical and economic burden on the US health care system, with acute exacerbations representing a key driver of direct medical costs. Current treatments, although effective in reducing symptoms and limiting exacerbations, do not adequately target the underlying disease processes that drive exacerbation development. The Aerobika* oscillating positive expiratory pressure (OPEP) device has been shown in a real-world effectiveness study to lower the frequency of moderate-to-severe exacerbations during a 30-day post-exacerbation period. This study sought to determine the impact on exacerbations and costs and to determine the cost-effectiveness of the Aerobika* device.

Methods: Data from published literature and national fee schedules were used to model the cost-effectiveness of the Aerobika* device in patients who had experienced an exacerbation in the previous month, or a post-exacerbation care population. Exacerbation trends and the impact of the Aerobika* device on reducing exacerbation frequency were modeled using a one-year Markov model with monthly cycles and three health states: (i) no exacerbation, (ii) exacerbation, and (iii) death. Scenario analysis and one-way sensitivity analysis (OWSA) were also performed.

Results: When the effect of Aerobika* device was assumed to last 30 days, use of the device resulted in cost-savings ($553 per patient) and improved outcomes (ie, six fewer exacerbations per 100 patients per year) compared to no OPEP/positive expiratory pressure therapy. When the effect of the Aerobika* device was assumed to extend beyond the conservative 30-day time frame, the Aerobika* device remained the dominant strategy (21 fewer exacerbations per 100 patients per year; cost savings of $1,952 per patient). Consistency in findings after performing OWSAs indicates the robustness of results.

Conclusion: The Aerobika* device is a cost-effective treatment option that provides clinical benefit and results in direct medical cost savings in a post-exacerbation care COPD population.

Keywords: Aerobika* device; COPD; cost-effectiveness; exacerbations.

Conflict of interest statement

Disclosure SKS and SK are employees of QuintilesIMS which received funding from Trudell Medical International, London, ON, for conducting this study and for the development of this paper. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Overview of the Markov model showing the three health states: (i) no exacerbation, (ii) exacerbation, and (iii) death. Patients with COPD entered the model in the “no-exacerbation” state, and based on different probabilities, transitioned to alternative states.
Figure 2
Figure 2
One-way sensitivity analysis in the post-exacerbation care population demonstrating the impact of adjusting individual model parameters on the cost-effectiveness of the Aerobika* device: (A) change in cost and (B) change in outcome.
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