# An Estimation of the Economic and Environmental Impact of Inhaler Devices Switch for Non-Clinical Reasons in COPD and Asthma: The Case for Spain

## TL;DR

Switching inhalers for non-clinical reasons in Spain leads to significant economic and environmental costs for COPD and asthma patients.

## Contribution

Quantifies the economic and environmental impact of non-clinical inhaler switching in Spain for COPD and asthma.

## Key findings

- Uncontrolled switching in COPD costs EUR 923/patient annually, totaling EUR 216 million.
- Asthma patients face EUR 263/patient annual costs, totaling EUR 118 million.
- Environmental impact is nearly 45,000 tCO2eq, with training reducing emissions by 2,600 tCO2eq.

## Abstract

In respiratory patients, limited adherence to and misuse of devices hinder the effectiveness of inhalation therapy. Switching inhalers for non-clinical reasons poses a risk of deterioration of respiratory disease and/or promotes poor adherence to therapy. The objective of this work was to explore the impact of device changes for non-clinical reasons on clinical outcomes (primary) and costs (secondary), including carbon emissions in Spain. After a comprehensive literature search, the increased use of resources following worsening outcomes was apportioned using Spanish cost data and following the recommended pathways for care. We calculated the cost of re-training these patients and attributed carbon emissions in metric tons of CO2 equivalent (tCO2eq) to the excess resource use. In Spain, the impact of uncontrolled switching for non-clinical reasons in COPD has an annual estimated cost of EUR 923/patient, leading to an excess annual expenditure of more than EUR 216 million. For asthma patients, the annual impact is almost EUR 263/patient, representing an additional EUR 118 million excess annual expenditure. The environmental consequence of both conditions can be equated to almost 45 thousand tCO2eq. Training all these patients on the new device would cost around EUR 35 million and would generate an extra impact reduction of about 2.6 thousand tCO2eq in carbon emissions levy.