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A1083 - Effects of Out-of-Pocket Costs on Patient Adherence with Asthma Medicines
Author Block: H. K. Reddel1, T. Laba2, S. Jan3, G. B. Marks1, A. Flynn4, E. Roughead5, A. Heaney6, K. Lembke6, N. Zwar7; 1Woolcock Inst of Medical Research, University of Sydney, Glebe, Australia, 2The George Institute and University of Sydney Menzies Centre for Health Policy, Sydney, Australia, 3The George Institute, Sydney, Australia, 4Asthma Foundation Australia, Sydney, Australia, 5School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia, 6NPS MedicineWise, Sydney, Australia, 7University of Wollongong, Wollongong, Australia.
Rationale: Patient adherence is poor in Australia despite universally subsidized medicines, and patient copayment may be a factor. We aimed to assess cost-related under-use of asthma medicines among Australian adults and children with asthma, and to identify associated factors. Methods: We conducted a cross sectional population-based online survey of adults (18 years or older) with asthma, and parents of children 5-17 years with asthma, using three-level random selection to avoid bias. The survey asked about cost-related adherence and compensatory behavior in the last year. Multiple regression analysis was used to identify factors associated with cost-related medicine underuse. Results: 792 adults with asthma (mean age 47; female 52.7%; concession 60.4%) and 609 parents of children with asthma (child 5-10 years 50.7%; female 40.2%, concession 52.9%) completed the survey. 419 (52.9%) of adults with asthma reported delaying or skipping refills, skipping doses or taking fewer puffs in the last 12 months because of cost, and 243 (30.7%) reported foregoing basic needs (e.g. food/heat) in the last 12 months to pay for asthma medicines. Corresponding results for parents of children with asthma were 209 (34.3%) and 269 (44.2%) respectively. Cost-related medicine under-use was lower amongst women, older patients and older parents of children; those not using any inhaled corticosteroids (adults only) or using fewer medicines (children only); those with no reported concerns about medicines; those who were more comfortable talking with their doctor about changing medicines (adults) or about medicine costs (children); parents who were more involved with the doctor in making medication-related decisions for their child; and participants/children with better asthma symptom control, no specialist visits, and no urgent asthma care in the previous 12 months. The effects were not modified by concessional status. Conclusions: Despite universal subsidies, cost-related underuse of asthma medicines is extremely common in Australia. Health professionals should be encouraged to ask patients if they have concerns about their asthma medicines including about cost; to optimize cost-effectiveness by checking inhaler technique and avoiding over-treatment; and to consider offering options with a lower overall out-of-pocket cost.