Cost saving of switching to equivalent inhalers and its effect on health outcomes.
Thorax
; 74(11): 1078-1086, 2019 11.
Article
en En
| MEDLINE
| ID: mdl-31383774
ABSTRACT
BACKGROUND:
Switching inhalers to cheaper equivalent products is often advocated as a necessary cost saving measure, yet the impact on patient's health and healthcare utilisation has not been measured.METHODS:
We identified asthma and chronic obstructive pulmonary disease (COPD) patients from UK primary care electronic healthcare records between 2000 and 2016. A self-controlled case series was used to estimate incidence rate ratios (IRR); comparing outcome rates during the risk period, 3 months after the exposure (financially motivated switch), and control periods (preswitch and postrisk period). Four outcomes were assessed disease exacerbation, general practitioner consultation, non-specific respiratory events and adverse-medication events. Medication possession ratio (MPR) was calculated to assess adherence. 2017 National Health Service indicative prices were used to estimate cost differences per equivalent dose.RESULTS:
We identified a cohort of 569 901 asthma and 171 231 COPD regular inhaler users, 2% and 6% had been switched, respectively. Inhaler switches between a brand-to-generic inhaler, and all other switches (brand-to-brand, generic-to-generic, generic-to-brand), were associated with reduced exacerbations (brand-to-generic IRR=0.75, 95% CI 0.64 to 0.88; all other IRR=0.79, 95% CI 0.71 to 0.88). Gender, age, therapeutic class, inhaler device and inhaler-technique checks did not significantly modify this association (p<0.05). The rate of consultations, respiratory-events and adverse-medication events did not change significantly (consultations IRR=1.00, 95% CI 0.99 to 1.01; respiratory-events IRR=0.96, 95% CI 0.95 to 0.97; adverse-medication-events IRR=1.05, 95% CI 0.96 to 1.15). Adherence significantly increased post-switch (median MPR pre-switch=54%, post-switch=62%; p<0.001). Switching patients, in the cohort of regular inhaler users, to the cheapest equivalent inhaler, could have saved around £6 million annually.CONCLUSION:
Switching to an equivalent inhaler in patients with asthma or COPD appeared safe and did not negatively affect patient's health or healthcare utilisation.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Asma
/
Nebulizadores y Vaporizadores
/
Ahorro de Costo
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Enfermedad Pulmonar Obstructiva Crónica
Tipo de estudio:
Health_economic_evaluation
Límite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
Thorax
Año:
2019
Tipo del documento:
Article
País de afiliación:
Reino Unido