Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study

Abstract

BackgroundAdherence to asthma and chronic obstructive pulmonary disease (COPD) treatment has been shown to depend on patient-level factors, such as disease severity, and medication-level factors, such as complexity. However, little is known about the impact of prescription charges – a factor at the health care system level. This study used real-life data to investigate whether co-payment affects adherence (implementation and persistence) and disease outcomes in patients with asthma or COPD.MethodsA matched, historical cohort study was carried out using two UK primary care databases. The exposure was co-payment for prescriptions, which is required for most patients in England but not in Scotland. Two comparison cohorts were formed: one comprising patients registered at general practices in England and the other comprising patients registered in Scotland. Patients aged 20–59 years with asthma, or 40–59 years with COPD, who were initiated on fluticasone propionate/salmeterol xinafoate, were included, matched to patients in the opposite cohort, and followed up for 1 year following fluticasone propionate/salmeterol xinafoate initiation. The primary outcome was good adherence, defined as medication possession ratio ≥80%, and was analyzed using conditional logistic regression. Secondary outcomes included exacerbation rate.ResultsThere were 1,640 patients in the payment cohort, ie, England (1,378 patients with asthma and 262 patients with COPD) and 619 patients in the no-payment cohort, ie, Scotland (512 patients with asthma and 107 patients with COPD). The proportion of patients with good adherence was 34.3% and 34.9% in the payment and no-payment cohorts, respectively, across both disease groups. In a multivariable model, no difference in odds of good adherence was found between the cohorts (odds ratio, 1.04; 95% confidence interval, 0.85–1.27). There was also no difference in exacerbation rate.ConclusionThere was no difference in adherence between matched patients registered in England and Scotland, suggesting that prescription charges do not have an impact on adherence to treatment.

Factors affecting the choice of therapeutic regimens in asthma and chronic obstructive pulmonary disease patients and patient adherence to the therapies prescribed

“…Reviewing the latest literature in the field of obstructive lung diseases, adherence to therapy in asthma and COPD was a frequent subject of research [4][5][6][7][8]. The results of the present study confirm that the GINA and GOLD guidelines are the essential factors determining the specialists' choice of therapy regimen.…”

“…The results of the present study confirm observation of poor adherence in COPD patients, what seems to be a serious clinical problem in all chronic respiratory diseases with hypoxemia. Cognitive dysfunction is frequently associated with a low socioeconomic status, another poor therapy adherence risk factor [4][5][6]. In the present study, the problem of non-compliance with the doctor's instructions was a frequent finding in less educated COPD and asthmatic patients.…”

“…In the present study, the agent price proved to be one of the key ones in terms of patients' treatment compliance, being clearly more often Paweł Nastałek, Adam Kurek, Agnieszka Almgren-Rachtan, Agnieszka Mastalerz-Migas, Zbigniew Doniec recognised by more experienced professionals. In contrast to this observation, Voorham et al [6] did not prove that prescription charges impact therapy adherence and diseases outcomes. It can be explained by differences in the healthcare system and general higher economic status in Western Europe countries comparing to Poland.…”

Factors affecting the choice of therapeutic regimens in asthma and chronic obstructive pulmonary disease patients and patient adherence to the therapies prescribed

“…The results of the present study confirm observation of poor adherence in COPD patients, what seems to be a serious clinical problem in all chronic respiratory diseases with hypoxemia. Cognitive dysfunction is frequently associated with a low socioeconomic status, another poor therapy adherence risk factor [4–6]. In the present study, the problem of non-compliance with the doctor’s instructions was a frequent finding in less educated COPD and asthmatic patients.…”

“…In the present study, the agent price proved to be one of the key ones in terms of patients’ treatment compliance, being clearly more often recognised by more experienced professionals. In contrast to this observation, Voorham et al [6] did not prove that prescription charges impact therapy adherence and diseases outcomes. It can be explained by differences in the healthcare system and general higher economic status in Western Europe countries comparing to Poland.…”