OBJECTIVES : There are a number of smart inhaler concepts in development, but a key question is what their impact is, and whether they are cost effective and in what settings. The objective was to develop an early economic model and based on current trial data explore cost effectiveness in a severe asthma population.

METHODS : A targeted literature review explored what models had been developed previously, as well as current asthma guidelines. A range of conceptual models were developed and following validation with clinical experts a Markov model was developed and populated with trial data. Outcomes are a function of the smartinhaler but also the interventions around it, so to demonstrate the minimum case the device was just the inhaler with reminder only. The model had a 1-year time horizon, and explored the cost-saving potential of the device vs SoC in a UK paediatric secondary care setting. A one-way sensitivity analysis was conducted.

RESULTS : The inhaler with alerts in paediatric secondary care is cost effective, and over one year is cost saving by £96 vs SoC. Wherever it is cost saving it dominates due to having higher incremental QALYs. The device was cost-saving across a range of scenarios at price of £100 (for device alone), and for different populations (including in adult secondary care).

CONCLUSIONS : Even at their most basic functionality, a smart inhaler is cost effective and cost saving in a paediatric secondary care setting. This combined with the need for an objective measure of adherence, suggests that smartinhalers should be considered as a cost effective tool in improving adherence and outcomes in secondary care. This model represents just one starting point and other asthma populations should be explored, as well as developing further models to investigate the cost effectiveness of such inhalers at different points of the asthma pathway.