Cost a barrier to asthma treatment: study

Half of adults and one-third of children in an Australian study were either decreasing or skipping doses of asthma medicines to make them last longer

A team of researchers led by The George Institute for Global Health and the Woolcock Institute of Medical Research surveyed 1,401 people with asthma across Australia—792 adults and 609 parents of children.

Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly by decreasing or skipping doses to make medicines last longer.

Over 40% of adults with asthma had not used an medication containing inhaled corticosteroids in the previous year, despite Australian guidelines recommending that these should be taken by almost all adults with asthma.

Odds of underuse were higher in younger adults, men, those with concerns about medicines, those who felt less comfortable talking to prescribers about cost or changing medicines, those who felt less engaged with prescribers about medicine decisions, those with poorer asthma control, and those requiring specialist or urgent health care visits.

For both adults and children, neither concession card status, income, nor their interaction was statistically significantly associated with cost-related underuse.

The exception was parents of children in a mid-range income household (AUD56,000- 78,000), who were at a higher odds of indicating cost-related underuse than those in the highest income bands (odds ratio: 1.83, 95% confidence interval: 1.03-3.26, < .05).

Senior Research Fellow Tracey-Lea Laba, of The George Institute, said the results published in the Journal of Allergy and Clinical Immunology: In Practice were especially concerning because around two thirds of adults and children had poorly controlled asthma symptoms.

The study showed about 45% of adults and 64% of children had required urgent healthcare treatment for their asthma in the previous year.

“Asthma affects around one in nine Australians and is one of the world’s leading causes of death and disability,” said Dr Laba.

“We know that preventer inhalers can be incredibly effective at controlling symptoms and preventing people from being hospitalised or even from dying of asthma, yet our study has found that out-of-pocket costs are preventing Australians from accessing medicines which can be life-saving.”

Co-author Professor Helen Reddel, of the Woolcock Institute, said it was clear that prescription costs were off-putting for many people with asthma in Australia.

“It all adds up and $40 a prescription is a lot of money for people on a budget. So you can start to understand why so many people with asthma are not taking preventer medications either correctly or at all,” said Professor Reddel.

“But asthma is a long-term disease and one where you really need to keep the inflammation under control by taking a preventative medicine and not just relying on short-term symptom relief from a blue inhaler.

“We need doctors to talk to their patients to stress that this band aid approach does not work, and can leave them hospitalised or even worse as a result.”

The paper calls for urgent interventions to promote discussions between patients and their GPs about the cost of medicines, including the availability of lower cost preventer treatments.

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