Medication-related costs of rhinitis in Australia: a NostraData cross-sectional study of pharmacy purchases

Abstract

PurposeThere is a relative paucity of research regarding medication expenditure associated with multiple-therapy use for rhinitis in Australia. To describe 1) the nature and extent of multiple-therapy use for rhinitis in Australia using data on therapies purchased with prescription or over-the-counter (OTC) and 2) additional costs incurred by multiple-therapy use compared with intranasal corticosteroid (INCS) therapy alone.Patients and methodsA retrospective observational study was carried out using a database containing anonymous pharmacy transaction data available from 20% of pharmacies in Australia that links doctor prescriptions and OTC purchase information. Pharmacy purchases of at least one prescription or OTC rhinitis treatment, with or without additional asthma/chronic obstructive pulmonary disease (COPD) therapy, by patients during 2013 and 2014 were assessed.ResultsIn total, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over 24 months. The majority of rhinitis therapy transactions were single-therapy purchases without additional asthma/COPD therapy. Of the single therapies purchased, 73% were oral antihistamines (OAHs) and 15% were INCS therapy. Dual-therapy purchases of INCSs and OAHs accounted for 40% of multiple-therapy purchases. Patients frequently purchased OAHs, nonsteroidal nasal sprays, and eye drops for allergic conjunctivitis alongside INCSs, resulting in higher financial costs (up to AU$21 per treatment episode) compared with INCS monotherapy.ConclusionThis study highlighted the significant burden posed on community pharmacy to address the needs of people with rhinitis symptoms, and the failure to translate the evidence that INCSs are the most effective monotherapy for moderate to severe and/or persistent rhinitis into clinical practice in light of the lack of evidence supporting combination of INCS and OAH therapy. Health care professional engagement, especially at the pharmacy level, will be extremely important if we wish to ensure that the purchase of rhinitis treatment is in accordance with guidelines and that their use is optimal.

Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease

“…Dual therapy of OAH and INS was the most common multiple-therapy purchased in this study, with higher purchasing rates for rhinitis and asthma/COPD patients (2.6%) than for rhinitis only patients (1.6%), despite the lack of clinical evidence supporting this practice, 3 , 4 which can incur additional costs (including costs associated with side effects from inappropriate medication use) to the patient. 14 , 29 , 32 , 38 This dual-therapy regimen frequently used by patients when monotherapy fails (whether OAH or INS) has been well documented by a number of studies. 25 , 40 , 41 Failure of INS monotherapy in controlling rhinitis symptoms could be due to poor intranasal device technique, 37 poor adherence to long-term therapy, polysensitization, 45 comorbidities, 3 – 5 , 18 mixed rhinitis, 1 , 2 misdiagnosis of rhinitis 46 and severe chronic upper airways disease.…”

“…In Australia, apart from reported patterns and costs of single and multiple-therapy purchases from pharmacies for rhinitis, 32 little is known about the nature and extent of rhinitis treatments purchases in different regions of Australia for patients with and without additional respiratory disease. Moreover, examining medication use for patients with and without additional respiratory disease may provide evidence for intervention regarding screening and OTC medication counseling protocols for pharmacists, scheduling of medicines and prescribing policies.…”

Analysis of Current Therapeutic Approaches to Chronic Rhinitis According to the Polyclinic Data of Ambulatory Service of Moscow

“…В Австралии проводили исследо-вание по продаже лекарственных средств по поводу АР на уровне аптек за 2013-2014 гг. В 73% приобретались антигистаминные препараты, в 15% -топические корти-костероиды, при этом в 40% ТКС брали вместе с анти-гистаминными препаратами [24]. В Великобритании в 2001 г. при аналогичном изучении аптечных продаж при АР в 70% приобретались антигистаминные средства, в 14% -ТКС [25], практически подобное соотношение в сторону предпочтения антигистаминных препаратов нового поколения наблюдалось и в Польше [26].…”

ARIA pharmacy 2018 “Allergic rhinitis care pathways for community pharmacy”

“…The specific role of pharmacists within ICPs can be evidenced through several strategies that have been initiated or completed in the AR management in the pharmacy, and in studies confirming the important impact of pharmacist interventions on AR outcomes . The specific areas of pharmacist impact in AR are summarized in Table .…”