Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences.
Division of Respiratory Medicine, Department of Medicine, and.
Ann Am Thorac Soc. 2024 Nov;21(11):1542-1549. doi: 10.1513/AnnalsATS.202402-130OC.
High costs of controller therapies may be a barrier to guideline-recommended asthma treatment. We determined whether eliminating out-of-pocket (OOP) payments among low-income patients with asthma impacted controller medication use. We applied a controlled interrupted time series design to administrative claims data in British Columbia, Canada from 2017 to 2020. Cases were individuals with an annual household income <$13,750 in whom copays were eliminated in January 2019; there was no change in public coverage for the control group with annual income >$45,000. We evaluated trends in asthma medication costs, use, the ratio of inhaled corticosteroid-containing medications to all asthma medications, excessive use of short-acting β-agonists (more than one canister per month), and the proportion of days covered by controller therapies. There were 12,940 cases (62% female; mean age, 30.3 yr; standard deviation [SD], 14.9) and 71,331 controls (55% female; mean age, 31.3 yr; SD, 16.3). Removal of OOP payments increased monthly mean medication costs by $3.32 (95% confidence interval [CI], $0.08 to $6.56, 2020 Canadian dollars), days' supply of controller medications by 1.50 days (95% CI, 0.61 to 2.40 d), and the ratio of inhaled corticosteroid-containing medications to total medications by 4.20% (95% CI, 0.73% to 7.66%) compared with the control group. The policy had no effect on the proportion of days covered by controller therapies (0.01; 95% CI, -0.01 to 0.04), but nonsignificantly decreased the percentage of patients with excessive short-acting β-agonist use (-6.37%; 95% CI, -12.90% to 0.16%). Removal of OOP payments increased the dispensation of controller therapies, suggesting cost-related nonadherence could impair optimal asthma management.
高成本的控制器疗法可能是阻碍指南推荐的哮喘治疗的一个障碍。我们确定了在哮喘低收入患者中消除自付费用（OOP）是否会影响控制器药物的使用。我们在加拿大不列颠哥伦比亚省的行政索赔数据中应用了对照中断时间序列设计，时间范围为 2017 年至 2020 年。病例是指年收入<13750 加元的个人，他们的自付费用在 2019 年 1 月被免除；年收入>45000 加元的对照组的公共保险没有变化。我们评估了哮喘药物费用、使用情况、含有吸入性皮质类固醇的药物与所有哮喘药物的比例、短效β-激动剂（每月超过一罐）的过度使用以及控制器疗法的覆盖天数的趋势。共有 12940 例病例（62%为女性；平均年龄 30.3 岁；标准差 [SD]，14.9）和 71331 例对照（55%为女性；平均年龄 31.3 岁；SD，16.3）。消除 OOP 支付增加了每月平均药物费用 3.32 加元（95%置信区间 [CI]，0.08 至 6.56，2020 年加元），控制器药物的供应天数增加了 1.50 天（95%CI，0.61 至 2.40d），含有吸入性皮质类固醇的药物与总药物的比例增加了 4.20%（95%CI，0.73%至 7.66%），与对照组相比。该政策对控制器疗法的覆盖率没有影响（0.01；95%CI，-0.01 至 0.04），但无显著降低过度使用短效β-激动剂的患者比例（-6.37%；95%CI，-12.90%至 0.16%）。消除 OOP 支付增加了控制器疗法的配给，这表明与成本相关的不依从可能会损害最佳哮喘管理。
