Holländer, J

Långström, D

Sandler, N

Santtila, P

Saukkonen, A

Torvinen, S

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 VA L U E  I N  H E A LT H  1 8  ( 2 0 1 5 )  A 3 3 5 – A 7 6 6  A363
life. When possible, meta-analysis was performed, evaluating the presence of het-
erogeneity and risk of publication bias. Otherwise, descriptive analysis of the avail-
able data was done. Results: Of the 10.348 original references scanned, 17 studies 
were finally selected, 7 experimental and 10 analytical. The population included 
was mainly adults, with type 2 diabetes. Important risk of bias was found in all of 
the articles, particularly the experimental ones. Meta-analysis was performed for 
glycemic control, hypoglycemia, adherence and persistence. Pen devices showed 
better results in mean HbA1c change, frequency of hypoglycemia, adherence and 
persistence compared to vial and syringes. No difference was observed in number 
of patients achieving < 7% of HbA1c. Studies regarding preference showed a clear 
tendency favorable to pen devices, but measurement methods were generally not 
well validated. One study on quality of life showed improvements in some subscales 
of SF-36. ConClusions: There is evidence that pen devices offer benefits regarding 
glycemic control, hypoglycemia, adherence, persistence, patient preference and 
quality of life compared to vial and syringes for insulin administration. However, 
data had considerable risk of bias, more methodologically sound studies are needed.
PMD108
HealtH State UtilitieS aSSociateD WitH attribUteS of Weekly 
injection DeviceS for treatMent of tyPe 2 DiabeteS
Matza LS1, Stewart KD1, Davies EW2, Paczkowski R3, Boye KS3
1Evidera, Bethesda, MD, USA, 2Evidera, London, UK, 3Eli Lilly and Company, Indianapolis, IN, USA
objeCtives: Several GLP-1 receptor agonists are available as weekly injections for 
treatment of type 2 diabetes. These medications vary in their injection delivery 
systems, and these differences could impact quality of life and patient preference. 
The purpose of this study was to estimate utilities associated with injection deliv-
ery systems for weekly GLP-1 therapies. Methods: Participants diagnosed with 
type 2 diabetes in the UK (Inverness, Portree, Edinburgh, London) valued health 
states in time trade-off (TTO) interviews. The health states (drafted based on lit-
erature, device instructions for use, and clinician interviews) had identical descrip-
tions of type 2 diabetes, but differed in description of the treatment process. One 
health state described an oral only treatment regimen (i.e., tablets), while six 
health states described oral treatment plus a weekly injection. The injection health 
states differed in the treatment administration process (e.g., requirements for 
reconstituting the medication, waiting during medication preparation, and nee-
dle handling). Results: A total of 209 participants completed interviews (57.4% 
male; mean age = 60.4y; 150 patients from Scotland and 59 from London). The 
mean (SD) utility of the oral treatment health state was 0.89 (0.12), and all injec-
tion health states had significantly (all p < 0.01) lower utilities ranging from 0.86 
(reconstitution, waiting, and handling) to 0.88 (weekly injection without any of the 
three treatment administration requirements). Utility differences among the injec-
tion health states suggest that each administration requirement had a small but 
measureable disutility (i.e., negative utility difference). Disutility values include 
-0.004 (reconstitution), -0.004 (needle handling), -0.010 (reconstitution, needle 
handling), and -0.020 (reconstitution, waiting, needle handling). ConClusions: 
Findings suggest that the TTO method may be used to quantify preferences among 
different injection treatment processes. It may be useful to incorporate these dif-
ferences into cost-utility models comparing among weekly injectable treatment 
for patients with type 2 diabetes.
PMD109
HealtH State UtilitieS aSSociateD WitH GlUcoSe MonitorinG DeviceS
Matza LS1, Stewart KD1, Davies EW2, Hellmund R3, Polonsky WH4, Kerr D5
1Evidera, Bethesda, MD, USA, 2Evidera, London, UK, 3Abbott Diabetes Care, Alameda, CA, USA, 
4University of California San Diego, San Diego, CA, USA, 5William Sansum Diabetes Center, Santa 
Barbara, CA, USA
objeCtives: Glucose monitoring is particularly important for patients with diabetes 
treated with insulin. Conventional self-monitoring of blood glucose (SMBG) requires 
a blood sample, typically obtained by pricking the finger with a lancing device. A 
new device (FreeStyle Libre™ flash glucose monitoring system) has been developed 
to monitor glucose levels with a sensor worn on the arm, without requiring blood 
samples. This study estimated utility associated with these two glucose monitoring 
approaches so that the values may be used in cost-utility models. Methods: In 
time trade-off (TTO) interviews, general population participants in the UK (London, 
Edinburgh) valued two health states which were drafted based on literature and 
clinician interviews. The health states had identical descriptions of diabetes and 
insulin treatment, but differed in glucose monitoring with either the FreeStyle 
Lite™ (SMBG) or the FreeStyle Libre (flash monitoring) system. Results: A total 
of 209 participants completed interviews (51.7% female; mean age = 42.1 y). Mean 
(SD) utilities were 0.851 (0.140) for SMBG and 0.882 (0.121) for flash monitoring 
(significant difference between the mean utilities; t = 8.3; p < 0.0001). Of the 209 
participants, 78 (37.3%) had a higher utility for flash monitoring, two (0.96%) had a 
higher utility for SMBG, and 129 (61.7%) had the same utility for both health states. 
The mean score on a seven-point preference scale ranging from strongly prefer flash 
monitoring (1) to strongly prefer SMBG (7) indicates that the participants generally 
preferred the flash monitoring system (mean = 1.8; SD = 1.5). ConClusions: The 
flash monitoring system was associated with significantly greater utility than SMBG. 
This difference can be used in cost-utility models, comparing the value of glucose 
monitoring devices for patients with diabetes. This study also demonstrates that the 
TTO method may be used to quantify preferences for medical devices.
PMD110
tHe iMPact of robotic tecHnoloGy on neUro-reHabilitation: 
PreliMinary reSUltS on accePtability anD effectiveneSS
Turchetti G1, Mazzoleni S2, Dario P2, Saldì D1, Guglielmelli E3
1Scuola Superiore Sant’Anna, Pisa, Italy, 2Scuola Superiore Sant’Anna, Pontedera (PI), Italy, 
3Università Campus Bio-Medico, Roma, Italy
objeCtives: Analysis of acceptability and effectiveness of upper limb rehabilitation 
treatments based on two robotic systems in stroke patients. Methods: Two specific 
Budesonide combination. For retired patients, visiting the GP increased the probabil-
ity of medication compliance. ConClusions: We concluded that inhaler devices 
influence patients’ compliance for long-term asthma medication. The impact of 
DPI on medication compliance was negative. We also identified some confounders 
of medication compliance such as patient’s age, severity of asthma, comorbidities 
and healthcare costs.
PMD105
evalUation of inHaler tecHniqUe MaStery anD HanDlinG errorS 
WitH SPiroMax®, eaSyHaler®, anD tUrbUHaler® DeviceS (finHaler)
Sandler N1, Holländer J1, Långström D1, Santtila P1, Saukkonen A2, Torvinen S3
1Åbo Akademi University, Turku, Finland, 2Teva Pharmaceuticals Finland, Espoo, Finland, 3Teva 
Pharmaceuticals Europe B.V., Amsterdam, The Netherlands
objeCtives: This single-site, cross-over study evaluated device mastery with dry 
powder inhalers, Spiromax®, Easyhaler® and Turbuhaler®. Methods: Healthy 
inhaler-naïve participants aged ≥ 18 years (N= 120) were observed using each of 
the three empty devices (Spiromax, Easyhaler, and Turbuhaler) in a counter-bal-
anced order. To evaluate the proportion of participants achieving device mastery 
(defined as an absence of health care professional [HCP] observed errors), a three 
step approach was used: 1) intuitive use (no instructions), 2) use after reading the 
patient information leaflet (PIL) user instructions and 3) use after HCP instructions. 
Trained HCPs monitored use and recorded errors based on device-specific handling 
error checklists. Results: During steps 1 and 2, respectively, more participants 
used Spiromax without error (37.5% and 93.3%; p< 0.001) compared with Easyhaler 
(0% and 58.3%) and Turbuhaler (9.2% and 76.7%); performance level was high (> 95%) 
with all devices during step 3. The mean proportion of errors committed by partici-
pants in steps 1 and 2 was lower with Spiromax (12.4%, 0.8%; p< 0.001) compared 
with Easyhaler (18.7%, 5.0%) and Turbuhaler (17.6%, 2.8%); the proportion of errors 
for each device was similar in step 3 (0.1%, 0.5%, 0.1%, respectively). The most com-
mon errors in step 1 were related to orientation for Spiromax (51.3%), shaking for 
Easyhaler (95.8%), and priming for Turbuhaler (55.8%). All findings were independent 
of age, gender, and education level. ConClusions: Spiromax was associated with 
higher levels of device mastery evidenced by intuitive use (no instructions) or PIL 
information, and fewer errors compared with Easyhaler and Turbuhaler. The most 
common errors associated with Spiromax were related to orientation. Assessing 
device mastery and providing training can improve drug effectiveness which may 
affect adherence and overall treatment costs.
PMD106
evalUation of inHaler PercePtion anD Preference of SPiroMax®, 
eaSyHaler®, anD tUrbUHaler® DeviceS (finHaler)
Sandler N1, Holländer J1, Långström D1, Santtila P1, Saukkonen A2, Torvinen S3
1Åbo Akademi University, Turku, Finland, 2Teva Pharmaceuticals Finland, Espoo, Finland, 3Teva 
Pharmaceuticals Europe B.V., Amsterdam, The Netherlands
objeCtives: Patient preference and overall satisfaction with their inhaler is cor-
related with improved adherence, better clinical outcomes and reduced costs. 
This single-site, cross-over study evaluated preference with dry powder inhal-
ers, Spiromax®, Easyhaler® and Turbuhaler®. Methods: Healthy inhaler-naïve 
participants aged ≥ 18 years (N= 120) were observed using each of the three empty 
devices (Spiromax, Easyhaler, and Turbuhaler) in a counter-balanced order. A three 
step approach was used: 1) intuitive use (no instructions), 2) use after reading the 
patient information leaflet (PIL) user instructions, and 3) use after health care 
professional instructions. Devices were rated using a device preference question-
naire after participants completed the three steps with each device. Participants 
were also asked to rate their satisfaction (on a scale from 1 [unsatisfactory] to 
5 [excellent]) with the following features: 1) overall ease of use, 2) quality of PIL 
instructions, 3) preparing the dose, 4) inhaling procedure, and 5) clarity of dose 
counter. Results: Spiromax was rated as the easiest device to use by 73.1% of 
participants, and 71.4% reported that if prescribed an inhaler they would prefer 
Spiromax. In comparison, 12.6% rated Easyhaler and 14.3% rated Turbuhaler as 
easiest to use; 16.8% and 11.8% would prefer Easyhaler and Turbuhaler, respec-
tively, if prescribed an inhaler. Participants rated Spiromax significantly higher 
compared to both Easyhaler and Turbuhaler (p< 0.001 for all comparisons) for all 
features except inhaling procedure, where no differences were found. Differences 
between Easyhaler and Turbuhaler were not significant with regards to any of the 
features analyzed except quality of PIL instructions, where Turbuhaler received 
higher ratings (p< 0.003), and clarity of the counter, where Easyhaler received 
higher ratings (p< 0.015). ConClusions: This study suggests that, if prescribed 
an inhaler product, device-naïve users prefer Spiromax and find it to be more 
intuitive in comparison to Easyhaler and Turbuhaler.
PMD107
Pen DeviceS for inSUlin aDMiniStration coMPareD to neeDle anD 
vial: SySteMatic revieW of literatUre anD Meta-analySiS
Lasalvia P1, Barahona J1, Romero D1, Gil S1, Castañeda-Cardona C1, Bayona JG1, Triana JJ1, 
Laserna A1, Restrepo P1, Mejía M1, Rosselli D2
1Pontificia Universidad Javeriana, Bogota, Colombia, 2Pontifícia Universidade Javeriana, Bogotá, 
Colombia
objeCtives: Studies suggest that “pen” devices offer advantages over traditional 
vial and syringe method for insulin administration. Our purpose was to evalu-
ate their efficacy safety and patient preference through a systematic review and 
meta-analysis. Methods: A systematic review was performed using an expert-
approved PICO question, in 8 different databases. References were screened by 
two independent investigators. Primary observational or experimental full articles 
comparing pen devices with vial and syringes for insulin administration in adults 
with diabetes mellitus were included (except gestational diabetes). Manual search 
for additional references was performed on selected articles. Risk of bias was evalu-
ated using the appropriate tools. We collected data on glycosylated hemoglobin 
(HbA1c), hypoglycemia, adherence, persistence, patient preference and quality of 


PMD105 Evaluation of Inhaler Technique Mastery and Handling Errors With Spiromax®, Easyhaler®, And Turbuhaler® Devices (Finhaler) 

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PMD105 Evaluation of Inhaler Technique Mastery and Handling Errors With Spiromax®, Easyhaler®, And Turbuhaler® Devices (Finhaler)

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