Cost saving of switching to equivalent inhalers and its effect on health outcomes
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| Název: | Cost saving of switching to equivalent inhalers and its effect on health outcomes |
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| Autoři: | Chloe I Bloom, Ian Douglas, Jack Olney, Grainne D'Ancona, Liam Smeeth, Jennifer K Quint |
| Zdroj: | Thorax. 74:1078-1086 |
| Informace o vydavateli: | BMJ, 2019. |
| Rok vydání: | 2019 |
| Témata: | Male, Respiratory System, General Practice, Muscarinic Antagonists, Pulmonary Disease, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, Adrenal Cortex Hormones/administration & dosage, 0302 clinical medicine, Adrenal Cortex Hormones, Cost Savings, Humans, inhaler devices, Aged, Assessment of Medication Adherence, Adrenergic beta-Agonists/administration & dosage, Nebulizers and Vaporizers, Muscarinic Antagonists/administration & dosage, Asthma/complications, 1103 Clinical Sciences, Nebulizers and Vaporizers/economics, asthma, Adrenergic beta-Agonists, Middle Aged, Asthma, United Kingdom, 3. Good health, Drug Combinations, General Practice/statistics & numerical data, Treatment Outcome, Medication Adherence/statistics & numerical data, Costs and Cost Analysis, Disease Progression, Female, COPD epidemiology, Cost Savings/statistics & numerical data, Chronic Obstructive/complications |
| Popis: | BackgroundSwitching inhalers to cheaper equivalent products is often advocated as a necessary cost saving measure, yet the impact on patient’s health and healthcare utilisation has not been measured.MethodsWe identified asthma and chronic obstructive pulmonary disease (COPD) patients from UK primary care electronic healthcare records between 2000 and 2016. A self-controlled case series was used to estimate incidence rate ratios (IRR); comparing outcome rates during the risk period, 3 months after the exposure (financially motivated switch), and control periods (preswitch and postrisk period). Four outcomes were assessed: disease exacerbation, general practitioner consultation, non-specific respiratory events and adverse-medication events. Medication possession ratio (MPR) was calculated to assess adherence. 2017 National Health Service indicative prices were used to estimate cost differences per equivalent dose.ResultsWe identified a cohort of 569 901 asthma and 171 231 COPD regular inhaler users, 2% and 6% had been switched, respectively. Inhaler switches between a brand-to-generic inhaler, and all other switches (brand-to-brand, generic-to-generic, generic-to-brand), were associated with reduced exacerbations (brand-to-generic: IRR=0.75, 95% CI 0.64 to 0.88; all other: IRR=0.79, 95% CI 0.71 to 0.88). Gender, age, therapeutic class, inhaler device and inhaler-technique checks did not significantly modify this association (pConclusionSwitching to an equivalent inhaler in patients with asthma or COPD appeared safe and did not negatively affect patient’s health or healthcare utilisation. |
| Druh dokumentu: | Article |
| Popis souboru: | application/pdf |
| Jazyk: | English |
| ISSN: | 1468-3296 0040-6376 |
| DOI: | 10.1136/thoraxjnl-2018-212957 |
| Přístupová URL adresa: | https://researchonline.lshtm.ac.uk/id/eprint/4656016/1/Bloom_2019_Switching%20inhaler.pdf https://pubmed.ncbi.nlm.nih.gov/31383774 https://spiral.imperial.ac.uk/handle/10044/1/71736 https://thorax.bmj.com/content/early/2019/08/05/thoraxjnl-2018-212957 https://thorax.bmj.com/content/74/11/1078 https://www.ncbi.nlm.nih.gov/pubmed/31383774 https://thorax.bmj.com/content/early/2019/08/05/thoraxjnl-2018-212957.abstract https://spiral.imperial.ac.uk/bitstream/10044/1/71736/2/Thorax_SCCS_MainDocument_final_REVISED3.docx http://hdl.handle.net/10044/1/71736 |
| Rights: | CC BY CC BY NC |
| Přístupové číslo: | edsair.doi.dedup.....abd8fdc9a02b04920b763851c5ff40c1 |
| Databáze: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstrakt: | BackgroundSwitching inhalers to cheaper equivalent products is often advocated as a necessary cost saving measure, yet the impact on patient’s health and healthcare utilisation has not been measured.MethodsWe identified asthma and chronic obstructive pulmonary disease (COPD) patients from UK primary care electronic healthcare records between 2000 and 2016. A self-controlled case series was used to estimate incidence rate ratios (IRR); comparing outcome rates during the risk period, 3 months after the exposure (financially motivated switch), and control periods (preswitch and postrisk period). Four outcomes were assessed: disease exacerbation, general practitioner consultation, non-specific respiratory events and adverse-medication events. Medication possession ratio (MPR) was calculated to assess adherence. 2017 National Health Service indicative prices were used to estimate cost differences per equivalent dose.ResultsWe identified a cohort of 569 901 asthma and 171 231 COPD regular inhaler users, 2% and 6% had been switched, respectively. Inhaler switches between a brand-to-generic inhaler, and all other switches (brand-to-brand, generic-to-generic, generic-to-brand), were associated with reduced exacerbations (brand-to-generic: IRR=0.75, 95% CI 0.64 to 0.88; all other: IRR=0.79, 95% CI 0.71 to 0.88). Gender, age, therapeutic class, inhaler device and inhaler-technique checks did not significantly modify this association (pConclusionSwitching to an equivalent inhaler in patients with asthma or COPD appeared safe and did not negatively affect patient’s health or healthcare utilisation. |
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| ISSN: | 14683296 00406376 |
| DOI: | 10.1136/thoraxjnl-2018-212957 |