BACKGROUND: More than 70% of patients with chronic obstructive pulmonary disease (COPD) make at least one critical error in using their inhaler. Critical handling errors limit effectiveness of pharmaceutical treatment with considerable negative clinical and economic consequences. Identifying errors and optimizing inhaler technique in routine care is resource intensive and training effects are usually not sustained beyond three months. Digital technologies for self-management of regular device training are a promising approach to optimize inhalation technique.

OBJECTIVES: To assess healthcare resource utilization (HRU) in conjunction with optimizing inhalation technique through digital biofeedback technology compared to standard care in COPD patients with frequent exacerbator phenotype.

METHODS: A deterministic markov model with a German payer perspective was developed to evaluate HRU. Systematic literature review informed effectiveness of digital interventions. Annual HRU for patients with and without critical handling errors was informed by a prospective cohort study by Melani et al. that enrolled 865 frequent exacerbator COPD patients. Costs for HRU were based on German reimbursement catalogues and analysis of the full German hospital statistics. Weighted mean costs were calculated to account for severe and moderate exacerbations, outpatient/emergency room admissions and acute pharmaceutical treatment.

RESULTS: Share of patients with at least one critical handling error was 71% for standard care and 18% for digital intervention. Total annual costs for adverse outcomes amounted to 5,231€ in the standard care group and 4,733€ in the digital intervention group. Accordingly, the cost offset under improved device handling was 498€ per patient per year.

CONCLUSIONS: Digital interventions have the potential to reduce exacerbations and annual HRU by 498€ per patient. This research considered a mixed mild to very severe COPD population with a focus on adverse outcomes. Therefore, cost-offset is likely higher in more severe populations. Further research with a cost consequence approach and longer time-horizon is recommended.