Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study

Jaco Voorham, Bernard Vrijens, Job FM van Boven, Dermot Ryan, Dermot Ryan, Marc Miravitlles, Lisa M. Law, David B Price

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Abstract

Background: Adherence to asthma and chronic obstructive pulmonary disease (COPD) treatment has been shown to depend on patient-level factors, such as disease severity, and medication-level factors, such as complexity. However, little is known about the impact of prescription charges – a factor at the health care system level. This study used real-life data to investigate whether co-payment affects adherence (implementation and persistence) and disease outcomes in patients with asthma or COPD.
Methods: A matched, historical cohort study was carried out using two UK primary care databases. The exposure was co-payment for prescriptions, which is required for most patients in England but not in Scotland. Two comparison cohorts were formed: one comprising patients registered at general practices in England and the other comprising patients registered in Scotland. Patients aged 20–59 years with asthma, or 40–59 years with COPD, who were initiated on fluticasone propionate/salmeterol xinafoate, were included, matched to patients in the opposite cohort, and followed up for 1 year following fluticasone propionate/salmeterol xinafoate initiation. The primary outcome was good adherence, defined as medication possession ratio ≥80%, and was analyzed using conditional logistic regression. Secondary outcomes included exacerbation rate.
Results: There were 1,640 patients in the payment cohort, ie, England (1,378 patients with asthma and 262 patients with COPD) and 619 patients in the no-payment cohort, ie, Scotland (512 patients with asthma and 107 patients with COPD). The proportion of patients with good adherence was 34.3% and 34.9% in the payment and no-payment cohorts, respectively, across both disease groups. In a multivariable model, no difference in odds of good adherence was found between the cohorts (odds ratio, 1.04; 95% confidence interval, 0.85–1.27). There was also no difference in exacerbation rate.
Conclusion: There was no difference in adherence between matched patients registered in England and Scotland, suggesting that prescription charges do not have an impact on adherence to treatment.
Original languageEnglish
Pages (from-to)31-41
Number of pages11
JournalPragmatic and Observational Research
Volume2017
Issue number8
DOIs
Publication statusPublished - 18 Apr 2017

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Nebulizers and Vaporizers
Cohort Studies
Equipment and Supplies
Chronic Obstructive Pulmonary Disease
Scotland
Therapeutics
Asthma
England
Prescriptions
General Practice

Keywords

  • implementation
  • adherence
  • asthma
  • chronic obstructive pulmonary statement
  • prescriptions
  • co-payment

Cite this

Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study. / Voorham, Jaco; Vrijens, Bernard ; van Boven, Job FM ; Ryan, Dermot; Ryan, Dermot; Miravitlles, Marc; Law, Lisa M.; Price, David B.

In: Pragmatic and Observational Research, Vol. 2017, No. 8, 18.04.2017, p. 31-41.

Research output: Contribution to journalArticle

Voorham, Jaco ; Vrijens, Bernard ; van Boven, Job FM ; Ryan, Dermot ; Ryan, Dermot ; Miravitlles, Marc ; Law, Lisa M. ; Price, David B. / Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study. In: Pragmatic and Observational Research. 2017 ; Vol. 2017, No. 8. pp. 31-41.
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abstract = "Background: Adherence to asthma and chronic obstructive pulmonary disease (COPD) treatment has been shown to depend on patient-level factors, such as disease severity, and medication-level factors, such as complexity. However, little is known about the impact of prescription charges – a factor at the health care system level. This study used real-life data to investigate whether co-payment affects adherence (implementation and persistence) and disease outcomes in patients with asthma or COPD.Methods: A matched, historical cohort study was carried out using two UK primary care databases. The exposure was co-payment for prescriptions, which is required for most patients in England but not in Scotland. Two comparison cohorts were formed: one comprising patients registered at general practices in England and the other comprising patients registered in Scotland. Patients aged 20–59 years with asthma, or 40–59 years with COPD, who were initiated on fluticasone propionate/salmeterol xinafoate, were included, matched to patients in the opposite cohort, and followed up for 1 year following fluticasone propionate/salmeterol xinafoate initiation. The primary outcome was good adherence, defined as medication possession ratio ≥80{\%}, and was analyzed using conditional logistic regression. Secondary outcomes included exacerbation rate.Results: There were 1,640 patients in the payment cohort, ie, England (1,378 patients with asthma and 262 patients with COPD) and 619 patients in the no-payment cohort, ie, Scotland (512 patients with asthma and 107 patients with COPD). The proportion of patients with good adherence was 34.3{\%} and 34.9{\%} in the payment and no-payment cohorts, respectively, across both disease groups. In a multivariable model, no difference in odds of good adherence was found between the cohorts (odds ratio, 1.04; 95{\%} confidence interval, 0.85–1.27). There was also no difference in exacerbation rate.Conclusion: There was no difference in adherence between matched patients registered in England and Scotland, suggesting that prescription charges do not have an impact on adherence to treatment.",
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T1 - Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study

AU - Voorham, Jaco

AU - Vrijens, Bernard

AU - van Boven, Job FM

AU - Ryan, Dermot

AU - Ryan, Dermot

AU - Miravitlles, Marc

AU - Law, Lisa M.

AU - Price, David B

N1 - The authors thank Derek Skinner for data extraction, Martina Stagno d’Alcontres and Susannah Thornhill for medical writing, and Lakmini Bulathsinhala for performing quality checks of statistical code and study support. This study was funded by TEVA Europe.

PY - 2017/4/18

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N2 - Background: Adherence to asthma and chronic obstructive pulmonary disease (COPD) treatment has been shown to depend on patient-level factors, such as disease severity, and medication-level factors, such as complexity. However, little is known about the impact of prescription charges – a factor at the health care system level. This study used real-life data to investigate whether co-payment affects adherence (implementation and persistence) and disease outcomes in patients with asthma or COPD.Methods: A matched, historical cohort study was carried out using two UK primary care databases. The exposure was co-payment for prescriptions, which is required for most patients in England but not in Scotland. Two comparison cohorts were formed: one comprising patients registered at general practices in England and the other comprising patients registered in Scotland. Patients aged 20–59 years with asthma, or 40–59 years with COPD, who were initiated on fluticasone propionate/salmeterol xinafoate, were included, matched to patients in the opposite cohort, and followed up for 1 year following fluticasone propionate/salmeterol xinafoate initiation. The primary outcome was good adherence, defined as medication possession ratio ≥80%, and was analyzed using conditional logistic regression. Secondary outcomes included exacerbation rate.Results: There were 1,640 patients in the payment cohort, ie, England (1,378 patients with asthma and 262 patients with COPD) and 619 patients in the no-payment cohort, ie, Scotland (512 patients with asthma and 107 patients with COPD). The proportion of patients with good adherence was 34.3% and 34.9% in the payment and no-payment cohorts, respectively, across both disease groups. In a multivariable model, no difference in odds of good adherence was found between the cohorts (odds ratio, 1.04; 95% confidence interval, 0.85–1.27). There was also no difference in exacerbation rate.Conclusion: There was no difference in adherence between matched patients registered in England and Scotland, suggesting that prescription charges do not have an impact on adherence to treatment.

AB - Background: Adherence to asthma and chronic obstructive pulmonary disease (COPD) treatment has been shown to depend on patient-level factors, such as disease severity, and medication-level factors, such as complexity. However, little is known about the impact of prescription charges – a factor at the health care system level. This study used real-life data to investigate whether co-payment affects adherence (implementation and persistence) and disease outcomes in patients with asthma or COPD.Methods: A matched, historical cohort study was carried out using two UK primary care databases. The exposure was co-payment for prescriptions, which is required for most patients in England but not in Scotland. Two comparison cohorts were formed: one comprising patients registered at general practices in England and the other comprising patients registered in Scotland. Patients aged 20–59 years with asthma, or 40–59 years with COPD, who were initiated on fluticasone propionate/salmeterol xinafoate, were included, matched to patients in the opposite cohort, and followed up for 1 year following fluticasone propionate/salmeterol xinafoate initiation. The primary outcome was good adherence, defined as medication possession ratio ≥80%, and was analyzed using conditional logistic regression. Secondary outcomes included exacerbation rate.Results: There were 1,640 patients in the payment cohort, ie, England (1,378 patients with asthma and 262 patients with COPD) and 619 patients in the no-payment cohort, ie, Scotland (512 patients with asthma and 107 patients with COPD). The proportion of patients with good adherence was 34.3% and 34.9% in the payment and no-payment cohorts, respectively, across both disease groups. In a multivariable model, no difference in odds of good adherence was found between the cohorts (odds ratio, 1.04; 95% confidence interval, 0.85–1.27). There was also no difference in exacerbation rate.Conclusion: There was no difference in adherence between matched patients registered in England and Scotland, suggesting that prescription charges do not have an impact on adherence to treatment.

KW - implementation

KW - adherence

KW - asthma

KW - chronic obstructive pulmonary statement

KW - prescriptions

KW - co-payment

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DO - 10.2147/POR.S132658

M3 - Article

VL - 2017

SP - 31

EP - 41

JO - Pragmatic and Observational Research

JF - Pragmatic and Observational Research

SN - 1179-7266

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ER -