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Does The Cost of Medicines to Patients Influence Guidelines-Based Prescribing and Utilisation? The Impact of Out-Of-Pocket Costs for Asthma Medicines on Patient and Prescriber Decisions in Australia
In Australia, one in 9 people are affected by asthma. Over $AUD600 million was spent on asthma in 2008-9 with half of this spend attributed to prescribed medicines.
Most Australians with asthma are prescribed inhaled corticosteroids (ICS) in a fixed dose combination inhaler with a long-acting beta agonist (ICS-LABA) to control their disease despite guidelines reserving ICS-LABAs for uncontrolled and more severe disease. ICS-LABAs are more expensive than ICS-alone inhalers for the Australian federal government - which subsidises the costs of medicines for Australians- and for patients, who pay a fixed co-payment with each medicine dispensed. Collectively, there is a strong clinical and financial argument to shift utilisation patterns towards ICS-alone therapy in Australia.
This presentation describes the findings from a National Health and Medical Research Council (NHMRC) funded partnership project that was undertaken to improve the guidelines-recommended use of ICS-containing medicines in Australia. This partnership was a multidisciplinary collaboration between key stakeholders in asthma management in Australia including respiratory and primary care clinicians, asthma advocacy groups, the National Prescribing Service (NPS), and health systems researchers from multiple academic institutions across Australia.
With evidence suggesting the influence of out-pocket costs on medicine utilisation in Australia, it was hypothesised that a patient-directed financial incentive, in the form of a lower co-payment for ICS-alone, could improve the guidelines recommended prescription and utilisation of ICS-containing medicines. The project comprised qualitative interviews with adults with asthma, parents of children with asthma and general practitioners as well as a quantitative study using a web-based survey that included a Discrete Choice Experiment.
In this presentation, I invite you to reflect on the following normative statements:
- Prescribers should consider patient costs in treatment decisions.
- In BC, the cost of medicines to Pharmacare should influence treatment decisions
- Cross-sectoral interventions must tackle the issue of cost-related underuse of medicines