Abstract
Background: Asthma is a leading, preventable cause of morbidity, mortality and cost. A disproportionate treatment at step 4–5 of the Global Initiative for Asthma (GINA) guidelines. We have previously demonstrated a high prevalence of nonadherence to inhaled combination therapy (i.e. long-acting β2-adrenoceptor agonist [β2-agonist] and corticosteroid) in this population. The aim of this study was to examine the costs of healthcare utilization in a nonadherent group of patients with difficult-to-control asthma compared with adherent subjects. We also wished to examine potential savings if nonadherence to inhaled combination therapy could be addressed. All costs were measured from the perspective of a publicly funded health service
Methods: Adherence was determined through examination of patient prescription refill behaviour and validated with a medical concordance interview. Data on healthcare use were collected from a patient survey and hospital records that included prescribed medicines, hospital admissions, intensive care unit (ICU) admissions and other unscheduled healthcare visits associated with asthma care. Activity was monetized using standard UK references and between-group comparisons based on a series of univariate and multivariate regression analyses.
Results: Cost differences were identified for inhaled combination therapy, nebulizer, short acting β2-agonists and hospital costs excluding and including ICU admissions between adherent and nonadherent subjects. Compared with a group who have refractory asthma and who are adherent with medication, additional healthcare costs in nonadherent subjects are offset by the reduction in costs associated with reduced medication utilization. However, if nonadherence can be successfully targeted and hospital admissions avoided in this population, there is a potential £475 (£843–£368) saving per patient, per annum.
Conclusion: Nonadherence is an important cause of difficult-to-control asthma. A uniform cost for subjects with difficult-to-control disease can be applied to economic analyses, independent of adherence, as increased healthcare utilization costs are offset by the reduced medication cost due to poor adherence. However, there are substantial potential savings in subjects with difficult-to-control asthma, who are nonadherent to inhaled combination therapy, if cost effective strategies for nonadherence are developed.
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Notes
As high-and low-cost estimates existed for a range of variables, various permutations of a total cost variable are possible. ‘High’ is used here to refer to a situation in which all elements of cost were set to the higher estimate in determination of the total figure and ‘low’ to refer to a situation in which all elements of cost were set to low estimate in determination of the total figure.
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Acknowledgements
Jacqui Gamble was funded by the Northern Ireland Research and Development Office Grant reference EAT/2747/04. Liam Heaney, MD, has received grant funding from Medimmune, Novartis UK, Genentech Inc., and GlaxoSmithKline (GSK), has served on Advisory Boards and has given lectures at meetings supported by GSK, Merck Sharpe & Dohme, Nycomed, Novartis and AstraZeneca. Dr Heaney has received support funding to attend international respiratory meetings (AstraZeneca, Chiesi, Novartis and GSK), and has taken part in asthma clinical trials (GSK and Genentech) for which his institution was remunerated. Ciaran O’Neill has received grant funding from GSK and has given lectures supported by GSK, Novartis and Pfizer for which his institution was remunerated. John Lindsay has no conflicts of interest to declare. No funding was provided for the conduct of this study.
Clinical data were collected as part of a routine clinical audit. Liam Heaney devised the original idea for the study, Jacqui Gamble and John Lindsay gathered the data, and Ciaran O’Neill undertook data analysis. All authors contributed to the drafting of the manuscript. The authors would like to thank Diarmuid Coughlan, a Health Research Board/ National Cancer Institute health economics fellow, for providing comments on an earlier draft of the paper.
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O’Neill, C., Gamble, J., Lindsay, J.T. et al. The Impact of Nonadherence to Inhaled Long-Acting β2-Adrenoceptor Agonist/Corticosteroid Combination Therapy on Healthcare Costs in Difficult-to-Control Asthma. Pharm Med 25, 379–385 (2011). https://doi.org/10.1007/BF03256881
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DOI: https://doi.org/10.1007/BF03256881