BACKGROUND: Up to 80% of patients with asthma do not use their inhaler device correctly and many clinicians cannot demonstrate correct inhaler use. Critical handling errors are associated with poor clinical outcomes in asthma with increased healthcare resource utilization (HRU). 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 HRU in conjunction with optimizing inhalation technique through digital technology compared to standard care in Asthma patients.

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 were mainly informed by a prospective cohort study by Westerik et al. that enrolled 623 asthma patients receiving ICS/LABA combination therapy. Costs for HRU were based on official German reimbursement catalogues and analysis of the German hospital statistics. Weighted mean costs were calculated to account for exacerbations with and without hospital admissions and acute pharmaceutical treatment.

RESULTS: Share of patients with at least one critical handling error was 79% for standard care and 13% for digital intervention. Total annual costs for adverse outcomes amounted to 1,850€ for standard care and 1,314€ for the digital intervention group. Accordingly, the cost offset under improved device handling was 536€ per patient per year.

CONCLUSIONS: Digital interventions have the potential to optimize inhalation technique reducing exacerbations and annual HRU by 536€ per patient. This research considered a mixed asthma population with a focus on adverse outcomes. Therefore, cost-offset is likely higher in an uncontrolled population. Further research with a cost consequence approach and longer time-horizon is recommended.