Cost-Related Underuse Of Medicines For Asthma - Opportunities For Improving Adherence

Tracey-Lea Laba, Stephen Jan, Nicholas A Zwar, Elizabeth Roughead, Anthony W Flynn, Michele D Goldman, Aine Heaney, Kirsty A Lembke, Helen K Reddel

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: In asthma, underuse of cost-effective preventive treatments increases morbidity and mortality. The cost of medicines contributes to underuse ('non-adherence'), but the extent to which people with asthma skip or reduce doses or let prescriptions go unfilled when faced with cost pressures is unknown.

AIMS: To estimate the extent of cost-related underuse behaviors and associated factors METHODS: Using previously validated summary indicators, we conducted an online cross-sectional survey of adults and parents of children 5-17 years with asthma in Australia (a high income country) and developed logistic regression models for adults and children with asthma, controlling for key clinical and demographic factors.

RESULTS: The survey was completed by n=792 adults (mean age 47 [SD 17] years, male 47%, concession 60%) and n=609 parents of children (5-10 years 51%, male 60%, concession 59%) with asthma. Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with: younger adults (adults: OR 1.19 95%CI 1.12, 1.27), males (adults: OR 1.49 95%CI 1.06, 2.08), having concerns about medicines (adults: OR 3.12 95%CI 2.17, 4.35; parents: OR 2.63 95%CI 1.56, 4.55) , less comfortable talking to prescribers about cost (parents: OR 1.22 95%CI 1.12, 1.33) or changing medicines (adults: OR 1.12 95%CI 1.03, 1.22), feeling less engaged with prescribers about medicine decisions (parents: OR 1.11 95%CI 1.01, 1.23), and with poorer asthma control (adults, poor control OR 1.87 95%CI 1.13, 3.09; parents, poor control: OR 3.87 95%CI 1.99, 7.54) and requiring specialist (parents: OR 1.83 95%CI 1.16, 2.87) or urgent healthcare visits (adults: OR 1.54 95%CI 1.06, 2.23). Income and concession card status were not associated with cost-related underuse.

CONCLUSIONS: Adults and parents of children with asthma indicate high rates of cost-related underuse of asthma medicines, even in the context of national medicines subsidies. Urgent targeting of interventions to promote discussion of medicines and costs between doctor and patients, particularly young adult males, is needed.

LanguageEnglish
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
Publication statusAccepted/In press - 27 Mar 2019

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Asthma
Parents
Costs and Cost Analysis
Young Adult
Logistic Models
Developed Countries
Prescriptions
Emotions
Cross-Sectional Studies
Medicine
Demography
Morbidity
Delivery of Health Care
Pressure
Mortality

Cite this

Laba, Tracey-Lea ; Jan, Stephen ; Zwar, Nicholas A ; Roughead, Elizabeth ; Flynn, Anthony W ; Goldman, Michele D ; Heaney, Aine ; Lembke, Kirsty A ; Reddel, Helen K. / Cost-Related Underuse Of Medicines For Asthma - Opportunities For Improving Adherence. In: Journal of Allergy and Clinical Immunology: In Practice. 2019.
@article{176bd1f5573f40eea15895e3d0c3450b,
title = "Cost-Related Underuse Of Medicines For Asthma - Opportunities For Improving Adherence",
abstract = "BACKGROUND: In asthma, underuse of cost-effective preventive treatments increases morbidity and mortality. The cost of medicines contributes to underuse ('non-adherence'), but the extent to which people with asthma skip or reduce doses or let prescriptions go unfilled when faced with cost pressures is unknown.AIMS: To estimate the extent of cost-related underuse behaviors and associated factors METHODS: Using previously validated summary indicators, we conducted an online cross-sectional survey of adults and parents of children 5-17 years with asthma in Australia (a high income country) and developed logistic regression models for adults and children with asthma, controlling for key clinical and demographic factors.RESULTS: The survey was completed by n=792 adults (mean age 47 [SD 17] years, male 47{\%}, concession 60{\%}) and n=609 parents of children (5-10 years 51{\%}, male 60{\%}, concession 59{\%}) with asthma. Cost-related underuse was reported by 52.9{\%} adults and 34.3{\%} parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with: younger adults (adults: OR 1.19 95{\%}CI 1.12, 1.27), males (adults: OR 1.49 95{\%}CI 1.06, 2.08), having concerns about medicines (adults: OR 3.12 95{\%}CI 2.17, 4.35; parents: OR 2.63 95{\%}CI 1.56, 4.55) , less comfortable talking to prescribers about cost (parents: OR 1.22 95{\%}CI 1.12, 1.33) or changing medicines (adults: OR 1.12 95{\%}CI 1.03, 1.22), feeling less engaged with prescribers about medicine decisions (parents: OR 1.11 95{\%}CI 1.01, 1.23), and with poorer asthma control (adults, poor control OR 1.87 95{\%}CI 1.13, 3.09; parents, poor control: OR 3.87 95{\%}CI 1.99, 7.54) and requiring specialist (parents: OR 1.83 95{\%}CI 1.16, 2.87) or urgent healthcare visits (adults: OR 1.54 95{\%}CI 1.06, 2.23). Income and concession card status were not associated with cost-related underuse.CONCLUSIONS: Adults and parents of children with asthma indicate high rates of cost-related underuse of asthma medicines, even in the context of national medicines subsidies. Urgent targeting of interventions to promote discussion of medicines and costs between doctor and patients, particularly young adult males, is needed.",
author = "Tracey-Lea Laba and Stephen Jan and Zwar, {Nicholas A} and Elizabeth Roughead and Flynn, {Anthony W} and Goldman, {Michele D} and Aine Heaney and Lembke, {Kirsty A} and Reddel, {Helen K}",
note = "Copyright {\circledC} 2019. Published by Elsevier Inc.",
year = "2019",
month = "3",
day = "27",
doi = "10.1016/j.jaip.2019.03.024",
language = "English",
journal = "Journal of Allergy and Clinical Immunology: In Practice",
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Cost-Related Underuse Of Medicines For Asthma - Opportunities For Improving Adherence. / Laba, Tracey-Lea; Jan, Stephen; Zwar, Nicholas A; Roughead, Elizabeth; Flynn, Anthony W; Goldman, Michele D; Heaney, Aine; Lembke, Kirsty A; Reddel, Helen K.

In: Journal of Allergy and Clinical Immunology: In Practice, 27.03.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cost-Related Underuse Of Medicines For Asthma - Opportunities For Improving Adherence

AU - Laba, Tracey-Lea

AU - Jan, Stephen

AU - Zwar, Nicholas A

AU - Roughead, Elizabeth

AU - Flynn, Anthony W

AU - Goldman, Michele D

AU - Heaney, Aine

AU - Lembke, Kirsty A

AU - Reddel, Helen K

N1 - Copyright © 2019. Published by Elsevier Inc.

PY - 2019/3/27

Y1 - 2019/3/27

N2 - BACKGROUND: In asthma, underuse of cost-effective preventive treatments increases morbidity and mortality. The cost of medicines contributes to underuse ('non-adherence'), but the extent to which people with asthma skip or reduce doses or let prescriptions go unfilled when faced with cost pressures is unknown.AIMS: To estimate the extent of cost-related underuse behaviors and associated factors METHODS: Using previously validated summary indicators, we conducted an online cross-sectional survey of adults and parents of children 5-17 years with asthma in Australia (a high income country) and developed logistic regression models for adults and children with asthma, controlling for key clinical and demographic factors.RESULTS: The survey was completed by n=792 adults (mean age 47 [SD 17] years, male 47%, concession 60%) and n=609 parents of children (5-10 years 51%, male 60%, concession 59%) with asthma. Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with: younger adults (adults: OR 1.19 95%CI 1.12, 1.27), males (adults: OR 1.49 95%CI 1.06, 2.08), having concerns about medicines (adults: OR 3.12 95%CI 2.17, 4.35; parents: OR 2.63 95%CI 1.56, 4.55) , less comfortable talking to prescribers about cost (parents: OR 1.22 95%CI 1.12, 1.33) or changing medicines (adults: OR 1.12 95%CI 1.03, 1.22), feeling less engaged with prescribers about medicine decisions (parents: OR 1.11 95%CI 1.01, 1.23), and with poorer asthma control (adults, poor control OR 1.87 95%CI 1.13, 3.09; parents, poor control: OR 3.87 95%CI 1.99, 7.54) and requiring specialist (parents: OR 1.83 95%CI 1.16, 2.87) or urgent healthcare visits (adults: OR 1.54 95%CI 1.06, 2.23). Income and concession card status were not associated with cost-related underuse.CONCLUSIONS: Adults and parents of children with asthma indicate high rates of cost-related underuse of asthma medicines, even in the context of national medicines subsidies. Urgent targeting of interventions to promote discussion of medicines and costs between doctor and patients, particularly young adult males, is needed.

AB - BACKGROUND: In asthma, underuse of cost-effective preventive treatments increases morbidity and mortality. The cost of medicines contributes to underuse ('non-adherence'), but the extent to which people with asthma skip or reduce doses or let prescriptions go unfilled when faced with cost pressures is unknown.AIMS: To estimate the extent of cost-related underuse behaviors and associated factors METHODS: Using previously validated summary indicators, we conducted an online cross-sectional survey of adults and parents of children 5-17 years with asthma in Australia (a high income country) and developed logistic regression models for adults and children with asthma, controlling for key clinical and demographic factors.RESULTS: The survey was completed by n=792 adults (mean age 47 [SD 17] years, male 47%, concession 60%) and n=609 parents of children (5-10 years 51%, male 60%, concession 59%) with asthma. Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with: younger adults (adults: OR 1.19 95%CI 1.12, 1.27), males (adults: OR 1.49 95%CI 1.06, 2.08), having concerns about medicines (adults: OR 3.12 95%CI 2.17, 4.35; parents: OR 2.63 95%CI 1.56, 4.55) , less comfortable talking to prescribers about cost (parents: OR 1.22 95%CI 1.12, 1.33) or changing medicines (adults: OR 1.12 95%CI 1.03, 1.22), feeling less engaged with prescribers about medicine decisions (parents: OR 1.11 95%CI 1.01, 1.23), and with poorer asthma control (adults, poor control OR 1.87 95%CI 1.13, 3.09; parents, poor control: OR 3.87 95%CI 1.99, 7.54) and requiring specialist (parents: OR 1.83 95%CI 1.16, 2.87) or urgent healthcare visits (adults: OR 1.54 95%CI 1.06, 2.23). Income and concession card status were not associated with cost-related underuse.CONCLUSIONS: Adults and parents of children with asthma indicate high rates of cost-related underuse of asthma medicines, even in the context of national medicines subsidies. Urgent targeting of interventions to promote discussion of medicines and costs between doctor and patients, particularly young adult males, is needed.

U2 - 10.1016/j.jaip.2019.03.024

DO - 10.1016/j.jaip.2019.03.024

M3 - Article

JO - Journal of Allergy and Clinical Immunology: In Practice

T2 - Journal of Allergy and Clinical Immunology: In Practice

JF - Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

ER -