Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
Ann Allergy Asthma Immunol. 2024 Feb;132(2):223-228.e8. doi: 10.1016/j.anai.2023.10.017. Epub 2023 Oct 21.
Cost-related nonadherence to medications can be a barrier to asthma management.
To quantify the impact of public drug plan deductibles on adherence to asthma medications.
We used a quasi-experimental regression discontinuity analysis to determine whether thresholds in deductibles for public drug coverage, determined on the basis of annual household income, decreased medication use among lower-income children and adults with asthma in British Columbia from 2013 to 2018. Using dispensed medication records, we evaluated deductible thresholds at annual household incomes of $15,000 (a deductible increase from 0% to 2% of annual household income), and $30,000 (a deductible increase from 2% to 3% annual household income). We evaluated medication costs, use, the ratio of inhaled corticosteroids-containing controller medications to total medications, excessive use of short-acting β-agonists, and the proportion of days covered by controller therapies. All costs are reported in 2020 Canadian dollars.
Overall, 88,935 individuals contributed 443,847 person-years of follow-up (57% of female sex, mean age 31 years). Public drug subsidy decreased by -$41.74 (95% CI, -$28.34 to -$55.13) at the $15,000-deductible threshold, a 28% reduction, and patient costs increased by $48.45 (95% CI, $35.37-$61.53). The $30,000 deductible threshold did not affect public drug costs (P = .31), but patient costs increased by $27.65 (95% CI, $15.22-$40.09), which is an 11% increase. Asthma-related medication use, inhaled corticosteroids-to-total medication ratio, excessive use of short-acting β-agonists, and proportion of days covered by controller therapies were not impacted by deductible thresholds.
Income-based deductibles reduced public drug costs with no effect on asthma-related medication use, adherence to controller therapies, or excessive reliever therapy use in lower-income individuals with asthma.
与药物相关的不依从可能是哮喘管理的障碍。
量化公共药物计划扣除额对哮喘药物依从性的影响。
我们使用准实验回归不连续性分析来确定不列颠哥伦比亚省 2013 年至 2018 年，公共药物覆盖的扣除额门槛（根据家庭年收入确定）是否会降低哮喘低收入儿童和成年人的药物使用量。使用配药记录，我们评估了家庭年收入为 15000 加元（扣除额从家庭年收入的 0%增加到 2%）和 30000 加元（扣除额从家庭年收入的 2%增加到 3%）的扣除额门槛。我们评估了药物费用、使用情况、含有吸入性皮质类固醇的控制器药物与总药物的比例、短效β-激动剂的过度使用以及控制器治疗的覆盖天数。所有费用均以 2020 年加元报告。
总体而言，88935 人共提供了 443847 人年的随访（57%为女性，平均年龄 31 岁）。在 15000 加元的扣除额门槛，公共药物补贴减少了-41.74 加元（95%CI，-28.34 至-55.13），减少了 28%，而患者费用增加了 48.45 加元（95%CI，35.37-61.53）。30000 加元的扣除额门槛没有影响公共药物费用（P=0.31），但患者费用增加了 27.65 加元（95%CI，15.22-40.09），增加了 11%。哮喘相关药物使用、吸入性皮质类固醇与总药物的比例、短效β-激动剂的过度使用以及控制器治疗的覆盖天数不受扣除额门槛的影响。
基于收入的扣除额降低了公共药物费用，而对哮喘相关药物使用、对控制器疗法的依从性或哮喘低收入个体过度缓解疗法的使用没有影响。
