The Impact of Eliminating Out-of-Pocket Payments on Asthma Medication Use.

Kate M Johnson, Lucy Cheng, Yiwei Yin, Rachel Carter, Santa Chow, Emily Brigham, Michael R Law
{"title":"The Impact of Eliminating Out-of-Pocket Payments on Asthma Medication Use.","authors":"Kate M Johnson, Lucy Cheng, Yiwei Yin, Rachel Carter, Santa Chow, Emily Brigham, Michael R Law","doi":"10.1513/AnnalsATS.202402-130OC","DOIUrl":null,"url":null,"abstract":"<p><p><b>Rationale:</b> High costs of controller therapies may be a barrier to guideline-recommended asthma treatment. <b>Objectives:</b> We determined whether eliminating out-of-pocket (OOP) payments among low-income patients with asthma impacted controller medication use. <b>Methods:</b> 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. <b>Results:</b> 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%). <b>Conclusions:</b> Removal of OOP payments increased the dispensation of controller therapies, suggesting cost-related nonadherence could impair optimal asthma management.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1542-1549"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the American Thoracic Society","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1513/AnnalsATS.202402-130OC","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Rationale: High costs of controller therapies may be a barrier to guideline-recommended asthma treatment. Objectives: We determined whether eliminating out-of-pocket (OOP) payments among low-income patients with asthma impacted controller medication use. Methods: 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. Results: 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%). Conclusions: Removal of OOP payments increased the dispensation of controller therapies, suggesting cost-related nonadherence could impair optimal asthma management.

取消自付费用对哮喘用药的影响。
背景:控制药物治疗的高昂费用可能会阻碍指南推荐的哮喘治疗。我们确定了取消低收入哮喘患者的自付费用(OOP)是否会影响控制药物的使用:我们对加拿大不列颠哥伦比亚省 2017-2020 年的行政报销数据采用了受控中断时间序列设计。病例为家庭年收入 45,000 美元的个人。我们评估了哮喘用药成本、使用情况、含吸入性皮质类固醇(ICS)药物占所有哮喘药物的比例、短效β-激动剂(SABA)的过度使用(>1罐/月)以及控制性疗法所覆盖的天数比例(PDC)等方面的趋势:共有 12,940 例病例(62% 为女性,平均年龄为 30.3 岁,SD 为 14.9)和 71,331 例对照组病例(55% 为女性,平均年龄为 31.3 岁,SD 为 16.3)。与对照组相比,取消 OOP 支付使每月平均药费增加了 3.32 加元(95% CI 为 0.08 - 6.56 加元,2020 年加元),控制药物供应天数增加了 1.50 天(95% CI 为 0.61 - 2.40),含 ICS 药物占总药物的比例增加了 4.20%(95% CI 为 0.73% - 7.66%)。该政策对控制疗法的 PDC 没有影响(0.01,95% CI -0.01 - 0.04),但非显著性地降低了过量使用 SABA 的患者比例(-6.37%;95% CI -12.90% - 0.16%):取消 OOP 支付增加了控制疗法的配药量,这表明与费用相关的不依从性可能会影响哮喘的最佳治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
10.00
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信