The cost of asthma medicines

Reddel, Helen K.; Lembke, Kirsty; Zwar, Nicholas

doi:10.18773/austprescr.2018.011

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…At month 12, in both the PAS and comparator arms, adherence was approximately 50%, which suggests only half the patients were having their asthma medications dispensed at appropriate intervals. Despite the known benefits of regular preventer use on symptomatic control of asthma and reducing long term risks, asthma patients are known to not take their preventer therapy regularly ( Ponieman et al, 2009 ; Boulet et al, 2012 ; Global Initiative for Asthma, 2018 ; Reddel et al, 2018 ; Riley et al, 2021 ). Rather, many people with asthma rely on reliever medications that provide immediate symptomatic relief and can be purchased without a prescription, at a lower price compared to preventer medicines in Australian pharmacies ( Reddel et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

A Targeted Approach to Improve Asthma Control Using Community Pharmacists

et al. 2021

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Background: Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice.Objective: This study investigates the efficacy of the PAS in improving asthma symptom control and other health outcomes.Methods: A two-arm pragmatic cluster randomized controlled trial was implemented in 95 pharmacies across three Australian States. Participants were adults with poorly controlled asthma as per the Asthma Control Questionnaire (ACQ), with or without allergic rhinitis. Patients within the PAS arm engaged in four consultations with the pharmacist over a 12-month period. An evidence-based algorithm guided pharmacies, via a trial specific software, to deliver a series of interventions targeting three issues underpinning uncontrolled asthma (medication use and adherence, inhaler technique, and allergic rhinitis management) to patient clinical asthma status and patient need. Comparator arm patients received a minimal intervention likened to usual practice involving referral of eligible patients to the GP and two follow-up consultations with their pharmacist to collect comparative data.Results: In total, 143 of 221 PAS patients (65%) and 111 of 160 comparator patients (69%) completed the trial. Improvements in asthma control were achieved in both the PAS (mean difference (MD) in ACQ from baseline = −1.10, p <.0001) and comparator (MD in ACQ from baseline = −0.94, p <.0001) arms at the trial end; however, there were no significant differences between the two arms (MD = −0.16, 95% CI −0.41 to 0.08, p = 0.19). Patients’ quality of life in the PAS arm improved significantly when compared with the comparator arm (MD in Impact of Asthma on Quality-of-Life Questionnaire (IAQLQ) = −0.52, 95% CI −0.89 to −0.14, p = 0.0079).Conclusion: Despite the PAS achieving a greater improvement in patients’ quality of life, the pharmacist-led service and usual practice arm produced comparable improvements in asthma control. These results ask us to reflect on current standards of usual care, as it appears the standard of asthma care in usual practice has evolved beyond what is reported in the literature.

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Section: Discussionmentioning

confidence: 99%

A Targeted Approach to Improve Asthma Control Using Community Pharmacists

et al. 2021

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“…For some asthma preventer medications, this could mean a saving of AUD 34.40 per supply, as per 2020 patient contribution fees [ 68 , 69 ]. It is known that out-of-pocket expenses can be a driving force in patient decision-making regarding adherence to therapy [ 21 , 32 ]. Our results supported this, showing that participants with a health care concession, who pay significantly less for preventer medications, were more adherent than those without.…”

Section: Discussionmentioning

confidence: 99%

“…Poor levels of adherence have been observed globally, reasons for which have been the focus of much research. A plethora of medication, patient and external factors drive both unintentional and intentional poor adherence [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Drivers often vary internationally, dependent on the sociopolitical context in which they are explored [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Even when taking preventers (ICS), many patients cannot correctly use inhalers as recommended, leading to sub-optimal dosing and unnecessary side effects [ 28 , 29 , 30 , 31 ]. Further, the rising costs of therapeutic management have been shown to play a role in patient decision-making regarding adherence to treatment [ 21 , 32 ]. Both direct and indirect expenses associated with the purchase of prescription preventer medications (ICS) for asthma can deter patient adherence and lead to a preference for relying on the less expensive reliever medications that can be purchased without a prescription in Australian pharmacies [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Medication Adherence in a Community Population with Uncontrolled Asthma

et al. 2020

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It is well documented that the use of medications in asthma and allergic rhinitis is often suboptimal, and consequently, patients remain symptomatic. This study aimed to determine the extent and type of medication-related issues contributing to poor asthma control by profiling medication management in those most at risk—a population with clinically uncontrolled asthma. Participants (n = 363) were recruited from Australian community pharmacies, and a dispensed medication history report for the previous 12 months was collected to examine medication adherence and factors affecting adherence. Information was also collected regarding participant asthma control and asthma/allergic rhinitis (if applicable) management. The participants’ mean asthma control score was 2.49 (± 0.89 SD, IQR = 1.20) (score ≥ 1.5 indicative of poorly controlled asthma), and 72% were either non-adherent or yet to initiate preventer therapy. Almost half had been prescribed high doses of inhaled corticosteroid and 24% reported use of oral corticosteroids. Only 22% of participants with concomitant allergic rhinitis were using first line treatment. A logistic regression model highlighted that participant health care concession status and hospital admissions were associated with better adherence. Suboptimal medication management is evident in this at-risk population.

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“…For as-needed budesonide-formoterol, with the usage seen in clinical trials (median 3-4 doses/week), the average monthly cost to the patient can be as little as one-sixth of that for a daily low-dose preventer, depending on the specific ICS. 18 Other updates in the 2020 Australian asthma guidelines…”

Section: Fig Selecting and Adjusting Asthma Medication For Adults Anmentioning

confidence: 99%

Updated Australian guidelines for mild asthma: what's changed and why?

Reddel¹

2020

Aust Prescr

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The Australian asthma guidelines have recently been updated and include additional treatment options for adults and adolescents with mild asthma. Mild asthma is not necessarily a benign condition and patients are still at risk of severe flare-ups, particularly if they overuse short-acting beta 2 agonists such as a salbutamol inhaler. For adults and adolescents with mild asthma, the updated guidelines include as-needed inhaled low-dose budesonide-formoterol as an alternative to daily low-dose inhaled corticosteroid plus as-needed short-acting beta 2 agonist. The budesonide-formoterol combination should be taken as needed to provide symptom relief and reduce the risk of severe exacerbations. Low-dose budesonide-formoterol Australian asthma guidelines now include as-needed inhaled low-dose budesonide-formoterol (eformoterol) for patients with mild asthma. Budesonide is an ICS and formoterol is a quick-onset long-acting beta 2 agonist (LABA). This combination gives rapid symptom relief and also reduces the risk of severe exacerbations. It provides an alternative to regular daily low-dose ICS plus an as-needed SABA (see Level 2 of treatment in Fig.

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The cost of asthma medicines

Cited by 10 publications

References 9 publications

A Targeted Approach to Improve Asthma Control Using Community Pharmacists

A Targeted Approach to Improve Asthma Control Using Community Pharmacists

Medication Adherence in a Community Population with Uncontrolled Asthma

Updated Australian guidelines for mild asthma: what's changed and why?

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