Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr 18;8:31-41.
doi: 10.2147/POR.S132658. eCollection 2017.

Does Co-Payment for Inhaler Devices Affect Therapy Adherence and Disease Outcomes? A Historical, Matched Cohort Study

Affiliations
Free PMC article

Does Co-Payment for Inhaler Devices Affect Therapy Adherence and Disease Outcomes? A Historical, Matched Cohort Study

Jaco Voorham et al. Pragmat Obs Res. .
Free PMC article

Abstract

Background: Adherence to asthma and chronic obstructive pulmonary disease (COPD) treatment has been shown to depend on patient-level factors, such as disease severity, and medication-level factors, such as complexity. However, little is known about the impact of prescription charges - a factor at the health care system level. This study used real-life data to investigate whether co-payment affects adherence (implementation and persistence) and disease outcomes in patients with asthma or COPD.

Methods: A matched, historical cohort study was carried out using two UK primary care databases. The exposure was co-payment for prescriptions, which is required for most patients in England but not in Scotland. Two comparison cohorts were formed: one comprising patients registered at general practices in England and the other comprising patients registered in Scotland. Patients aged 20-59 years with asthma, or 40-59 years with COPD, who were initiated on fluticasone propionate/salmeterol xinafoate, were included, matched to patients in the opposite cohort, and followed up for 1 year following fluticasone propionate/salmeterol xinafoate initiation. The primary outcome was good adherence, defined as medication possession ratio ≥80%, and was analyzed using conditional logistic regression. Secondary outcomes included exacerbation rate.

Results: There were 1,640 patients in the payment cohort, ie, England (1,378 patients with asthma and 262 patients with COPD) and 619 patients in the no-payment cohort, ie, Scotland (512 patients with asthma and 107 patients with COPD). The proportion of patients with good adherence was 34.3% and 34.9% in the payment and no-payment cohorts, respectively, across both disease groups. In a multivariable model, no difference in odds of good adherence was found between the cohorts (odds ratio, 1.04; 95% confidence interval, 0.85-1.27). There was also no difference in exacerbation rate.

Conclusion: There was no difference in adherence between matched patients registered in England and Scotland, suggesting that prescription charges do not have an impact on adherence to treatment.

Keywords: adherence; asthma; chronic obstructive pulmonary disease; co-payment; implementation; prescriptions.

Conflict of interest statement

Disclosure JV and LML are employed by Observational & Pragmatic Research Institute Pte Ltd, Singapore, which receives funding from UK National Health Service, British Lung Foundation, Aerocrine, AKL Ltd, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Eli Lilly, GlaxoSmithKline, Meda, Merck, Mundipharma, Napp, Novartis, Orion, Pfizer, Respiratory Effectiveness Group, Takeda, Teva Pharmaceuticals, and Zentiva. JFMvB’s institution has received study grants from GlaxoSmithKline, Novartis, AstraZeneca, and Boehringer Ingelheim and consultancy fees from AstraZeneca. DR has received personal fees for lectures from Chiesi, AstraZeneca, Takeda, Boehringer Ingelheim, Novartis, and Teva and for advisory boards from Teva, Chiesi, Boehringer Ingelheim, and Novartis. MM has received speaker fees from Boehringer Ingelheim, AstraZeneca, Chiesi, GlaxoSmithKline, Menarini, Teva, Grifols, and Novartis and consulting fees from Bayer Schering, Boehringer Ingelheim, GlaxoSmithKline, Gebro Pharma, CLS Behring, Cipla, MediImmune, Mereo Biopharma, Teva, Novartis, and Grifols. DBP has a board membership with Aerocrine, Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, and Teva; received consultancy fees from Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Mundipharma, Napp, Novartis, Pfizer, Teva, and Zentiva; grants/grants pending with UK National Health Service, British Lung Foundation, Aerocrine, AstraZeneca, Boehringer Ingelheim, Chiesi, Eli Lilly, GlaxoSmithKline, Meda, Merck, Mundipharma, Novartis, Orion, Pfizer, Respiratory Effectiveness Group, Takeda, Teva, and Zentiva; received payments for lectures/speaking from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Meda, Merck, Mundipharma, Novartis, Pfizer, SkyePharma, Takeda, and Teva; received payment for manuscript preparation from Mundipharma and Teva; received patents (planned, pending, or issued) from AKL Ltd.; received payment for the development of educational materials from GlaxoSmithKline, Novartis; has stock/stock options with shares in AKL Ltd, which produces phytopharmaceuticals and owns 80% of research in Real Life Ltd, 75% of the social enterprise Optimum Patient Care Ltd, and 75% of Observational & Pragmatic Research Institute Pte Ltd; received payment for travel/accommodations/meeting expenses from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis, and Teva; funding for patient enrolment or completion of research: Almirral, Chiesi, Teva, and Zentiva; is a peer reviewer for grant committees of Medical Research Council (2014), Efficacy and Mechanism Evaluation Programme (2012), and HTA (2014); and received unrestricted funding for investigator-initiated studies from Aerocrine, AKL Ltd, Almirall, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, Orion, Takeda, Teva, and Zentiva. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of medication possession ratio (%) in matched cohorts.

Similar articles

See all similar articles

Cited by 1 article

References

    1. World Health Organisation global Surveillance, Prevention and Control of Chronic Respiratory Diseases: A Comprehensive Approach. 2007. [Accessed October 26, 2016]. Available from: http://www.who.int/gard/publications/GARD%20Book%202007.pdf.
    1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–497. - PubMed
    1. Vrijens B, De Geest S, Hughes DA, et al. ABC Project Team A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705. - PMC - PubMed
    1. Covvey JR, Mullen AB, Ryan M, et al. A comparison of medication adherence/persistence for asthma and chronic obstructive pulmonary disease in the United Kingdom. Int J Clin Pract. 2014;68(10):1200–1208. - PubMed
    1. Mueller S, Wilke T, Bechtel B, Punekar YS, Mitzner K, Virchow JC. Non-persistence and non-adherence to long-acting COPD medication therapy: a retrospective cohort study based on a large German claims dataset. Respir Med. 2017;122:1–11. - PubMed

LinkOut - more resources

Feedback