Smith Pete, Price David, Harvey Richard, Carney Andrew Simon, Kritikos Vicky, Bosnic-Anticevich Sinthia Z, Christian Louise, Skinner Derek, Carter Victoria, Durieux Alice Marie Sybille
Clinical Medicine, Griffith University, Southport, QLD, Australia.
Observational and Pragmatic Research Institute, Singapore.
J Asthma Allergy. 2017 May 9;10:153-161. doi: 10.2147/JAA.S128431. eCollection 2017.
There is a relative paucity of research regarding medication expenditure associated with multiple-therapy use for rhinitis in Australia. To describe 1) the nature and extent of multiple-therapy use for rhinitis in Australia using data on therapies purchased with prescription or over-the-counter (OTC) and 2) additional costs incurred by multiple-therapy use compared with intranasal corticosteroid (INCS) therapy alone.
A retrospective observational study was carried out using a database containing anonymous pharmacy transaction data available from 20% of pharmacies in Australia that links doctor prescriptions and OTC purchase information. Pharmacy purchases of at least one prescription or OTC rhinitis treatment, with or without additional asthma/chronic obstructive pulmonary disease (COPD) therapy, by patients during 2013 and 2014 were assessed.
In total, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over 24 months. The majority of rhinitis therapy transactions were single-therapy purchases without additional asthma/COPD therapy. Of the single therapies purchased, 73% were oral antihistamines (OAHs) and 15% were INCS therapy. Dual-therapy purchases of INCSs and OAHs accounted for 40% of multiple-therapy purchases. Patients frequently purchased OAHs, nonsteroidal nasal sprays, and eye drops for allergic conjunctivitis alongside INCSs, resulting in higher financial costs (up to AU$21 per treatment episode) compared with INCS monotherapy.
This study highlighted the significant burden posed on community pharmacy to address the needs of people with rhinitis symptoms, and the failure to translate the evidence that INCSs are the most effective monotherapy for moderate to severe and/or persistent rhinitis into clinical practice in light of the lack of evidence supporting combination of INCS and OAH therapy. Health care professional engagement, especially at the pharmacy level, will be extremely important if we wish to ensure that the purchase of rhinitis treatment is in accordance with guidelines and that their use is optimal.
在澳大利亚，关于鼻炎多药联合治疗的药物支出研究相对较少。本研究旨在：1）利用处方购买或非处方（OTC）购买疗法的数据，描述澳大利亚鼻炎多药联合治疗的性质和程度；2）与单独使用鼻用糖皮质激素（INCS）治疗相比，多药联合治疗产生的额外费用。
开展一项回顾性观察研究，使用一个数据库，该数据库包含澳大利亚20%药房提供的匿名药房交易数据，这些数据将医生处方和OTC购买信息联系起来。评估了2013年和2014年期间患者购买至少一种处方或OTC鼻炎治疗药物（无论是否伴有额外的哮喘/慢性阻塞性肺疾病（COPD）治疗）的情况。
在24个月内，从909家药房共购买了4,247,193次处方和OTC鼻炎治疗药物。大多数鼻炎治疗交易为不伴有额外哮喘/COPD治疗的单药购买。在购买的单药中，73%为口服抗组胺药（OAH），15%为INCS治疗。INCS与OAH的联合治疗购买量占多药联合治疗购买量的40%。患者经常在使用INCS的同时购买OAH、非甾体类鼻喷雾剂和用于过敏性结膜炎的眼药水，与INCS单药治疗相比，这导致了更高的经济成本（每次治疗高达21澳元）。
本研究强调了社区药房为满足鼻炎症状患者需求所承担的重大负担，以及鉴于缺乏支持INCS与OAH联合治疗的证据，未能将INCS是中度至重度和/或持续性鼻炎最有效单药治疗的证据转化为临床实践。如果我们希望确保鼻炎治疗药物的购买符合指南且使用最佳，医疗保健专业人员的参与，尤其是在药房层面，将极其重要。
