Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis

Tracey-Lea Laba, Helen K Reddel, Nicholas J Zwar, Guy B Marks, Elizabeth Roughead, Anthony Flynn, Michele Goldman, Aine Heaney, Kirsty Lembke, Stephen Jan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: In Australia, many patients who are initiated on asthma controller inhalers receive combination inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) despite having asthma of sufficiently low severity that ICS-alone would be equally effective and less costly for the government.

METHODS: We conducted a discrete choice experiment (DCE) in a nationally representative sample of adults (n = 792) and parents of children (n = 609) with asthma. Mixed multinomial models were estimated and calibrated to reflect the estimated market shares of ICS-alone, ICS/LABA and no controller. We then simulated the impact of varying patient co-payment on demand and the financial impact on government pharmaceutical expenditure.

RESULTS: Preference for inhaler decreased with increasing costs to the patient or government, increasing chance of a repeat visit to the doctor, and if fewer symptoms were present. Adults preferred high-strength controllers, but parents preferred low-strength inhalers for children (general beneficiaries only). The DCE predicted a higher proportion choosing controller treatment (89%) compared to current levels (57%) at the current co-payment level, with proportionately higher uptake of ICS-alone and a lower average cost per patient [32.73 Australian dollars (AU$) c.f. AU$38.54]. Reducing the co-payment on ICS-alone by 50% would increase its market share to 50%, whilst completely removing the co-payment would only have a small marginal impact on market share, but increased average cost of treatment to the government to AU$41.04 per person.

CONCLUSIONS: Patient-directed financial incentives are unlikely to encourage much switching of medicines, and current levels of under-treatment are not explained by patient preferences. Interventions directed at prescribers are more likely to promote better use of asthma medicines.

Original languageEnglish
Pages (from-to)227-238
Number of pages12
JournalPharmacoEconomics
Volume37
Issue number2
DOIs
Publication statusPublished - 13 Feb 2019
Externally publishedYes

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Motivation
Asthma
Nebulizers and Vaporizers
Adrenal Cortex Hormones
Parents
Costs and Cost Analysis
Patient Preference
Health Expenditures
Health Care Costs
Therapeutics
Pharmaceutical Preparations

Cite this

Laba, Tracey-Lea ; Reddel, Helen K ; Zwar, Nicholas J ; Marks, Guy B ; Roughead, Elizabeth ; Flynn, Anthony ; Goldman, Michele ; Heaney, Aine ; Lembke, Kirsty ; Jan, Stephen. / Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis. In: PharmacoEconomics. 2019 ; Vol. 37, No. 2. pp. 227-238.
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Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis. / Laba, Tracey-Lea; Reddel, Helen K; Zwar, Nicholas J; Marks, Guy B; Roughead, Elizabeth; Flynn, Anthony; Goldman, Michele; Heaney, Aine; Lembke, Kirsty; Jan, Stephen.

In: PharmacoEconomics, Vol. 37, No. 2, 13.02.2019, p. 227-238.

Research output: Contribution to journalArticleResearchpeer-review

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N2 - BACKGROUND: In Australia, many patients who are initiated on asthma controller inhalers receive combination inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) despite having asthma of sufficiently low severity that ICS-alone would be equally effective and less costly for the government.METHODS: We conducted a discrete choice experiment (DCE) in a nationally representative sample of adults (n = 792) and parents of children (n = 609) with asthma. Mixed multinomial models were estimated and calibrated to reflect the estimated market shares of ICS-alone, ICS/LABA and no controller. We then simulated the impact of varying patient co-payment on demand and the financial impact on government pharmaceutical expenditure.RESULTS: Preference for inhaler decreased with increasing costs to the patient or government, increasing chance of a repeat visit to the doctor, and if fewer symptoms were present. Adults preferred high-strength controllers, but parents preferred low-strength inhalers for children (general beneficiaries only). The DCE predicted a higher proportion choosing controller treatment (89%) compared to current levels (57%) at the current co-payment level, with proportionately higher uptake of ICS-alone and a lower average cost per patient [32.73 Australian dollars (AU$) c.f. AU$38.54]. Reducing the co-payment on ICS-alone by 50% would increase its market share to 50%, whilst completely removing the co-payment would only have a small marginal impact on market share, but increased average cost of treatment to the government to AU$41.04 per person.CONCLUSIONS: Patient-directed financial incentives are unlikely to encourage much switching of medicines, and current levels of under-treatment are not explained by patient preferences. Interventions directed at prescribers are more likely to promote better use of asthma medicines.

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