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[email protected] http s ://eprints.whiterose.ac.uk/ Health Technology Assessment 2002; Vol. 6: No. 5 The clinical effectiveness and cost- effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation J Peters M Stevenson C Beverley JNW Lim S Smith Health Technology Assessment NHS R&D HTA Programme HTA HTA How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (http://www.ncchta.org). A fully searchable CD-ROM is also available (see below). Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents, York Publishing Services. Non-UK purchasers will have to pay a small fee for post and packing. 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The clinical effectiveness and cost- effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation J Peters1* M Stevenson1 C Beverley1 JNW Lim2 S Smith3 1 School of Health and Related Research (ScHARR), University of Sheffield, UK 2 Nuffield Institute for Health, University of Leeds, UK 3 Easington Primary Care Group, Peterlee, UK * Corresponding author Competing interests: none declared Published July 2002 This report should be referenced as follows: Peters J, Stevenson M, Beverley C, Lim JNW, Smith S.The clinical effectiveness and cost-effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation. Health Technol Assess 2002;6(5). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see opposite). NHS R&D HTA Programme he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure T that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. The research reported in this monograph was commissioned by the HTA Programme on behalf of the National Institute for Clinical Excellence (NICE). Rapid reviews are completed in a limited time to inform the appraisal and guideline development processes managed by NICE. The review brings together evidence on key aspects of the use of the technology concerned. However, appraisals and guidelines produced by NICE are informed by a wide range of sources. The research reported in this monograph was funded as project number 00/22/01. The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme, NICE or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed ‘systematic’ when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA Programme Director: Professor Kent Woods Series Editors: Professor Andrew Stevens, Dr Ken Stein, Professor John Gabbay, Dr Ruairidh Milne, Dr Tom Dent and Dr Chris Hyde Monograph Editorial Manager: Melanie Corris The editors and publisher have tried to ensure the accuracy of this report but do not accept liability for damages or losses arising from material published in this report. ISSN 1366-5278 © Queen’s Printer and Controller of HMSO 2002 This monograph may be freely reproduced for the purposes of private research and study and may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to HMSO,The Copyright Unit, St Clements House, 2–16 Colegate, Norwich, NR3 1BQ. Published by Core Research, Alton, on behalf of the NCCHTA. Printed on acid-free paper in the UK by The Basingstoke Press, Basingstoke. R Health Technology Assessment 2002; Vol. 6: No. 5 Contents List of abbreviations .................................... i Appendix 8 DPIs vs DPIs, delivering bronchodilating drugs .................................. 93 Executive summary .................................... iii 1 Background .................................................. 1 Appendix 9 pMDIs with or without spacer Description of underlying health problem .. 1 vs pMDIs with or without spacer, with the Current service provision .............................. 3 same propellants, delivering corticosteroids 97 Description of intervention .......................... 4 Appendix 10 pMDIs with or without spacer Scope of the review ........................................ 13 vs DPIs, delivering corticosteroids ................ 99 2 Effectiveness .................................................. 15 Methods for reviewing effectiveness ............ 15 Appendix 11 DPIs vs DPIs, delivering Results ............................................................ 16 corticosteroids ................................................ 105 3 Economic analysis ........................................ 27 Appendix 12 pMDIs with or without spacer Methods for economic analysis .................... 27 vs breath-actuated devices, delivering anti- Review of the economic submissions and inflammatory drugs: sodium cromoglicate .. 109 published literaure ........................................ 27 Review group model ...................................... 34 Appendix 13 pMDIs with or without spacer vs pMDIs with or without spacer, with 4Implications for other parties .................... 37 different propellants, delivering the same 5Factors relevant to the NHS...................... 39 bronchodilating drugs .................................. 111 6Discussion ...................................................... 41 Appendix 14 pMDIs with or without spacer vs pMDIs with or without spacer, with 7 Conclusions .................................................. 43 different propellants, delivering cortico- 8 Budgetary impact modelling...................... 45 steroids or combined therapy........................ 117 Acknowledgements.....................................