Breathing easier - Asthma Foundation aims to cut the cost of asthma meds
Asthma Foundation NSW on behalf of Asthma Australia, and in partnership with UNSW Australia, Woolcock Institute, George Institute and NPS Medicine Wise, has secured a National Health and Medical Research (NHMRC) Partnership Grant to explore how to cut the cost of asthma medication to consumers and what the impact of reduced costs will be.
“Asthma Foundation NSW has been a consumer organisation for over 50 years and our mission is to understand people’s needs. Multiple studies and surveys tell us the cost of medication - the cornerstone of treatment for lifelong chronic conditions like asthma - is an ongoing issue for the 1:10 adults and children who live with asthma,” said Michele Goldman, CEO of Asthma Foundation NSW.
“Affordable medication is, by far, the cheapest way to keep asthmatics well controlled and out of GP surgeries, accident and emergency departments or hospitals where the cost of managing their asthma rises considerably.
“This is an innovative research project which seeks to explore if there is potential to allocate the current PBS investment more effectively in order to lower the price of some preventer medications, and in the longer term, reduce the burden on the health system.”
Daily preventer medication stops underlying symptoms building into a potentially life-threatening asthma attack. Each inhaler (which costs around $36) should last 4 weeks if used daily as directed.
Pharmaceutical Benefits Scheme (PBS) data shows only 18% fill preventer scripts often enough for prescribed daily use.[i] However, people holding a concession card were dispensed over 2.5 times the number of ICS prescriptions than people without one.[ii] As the cost to someone without a healthcare card is over six times higher than for cardholders, these findings point to cost as a barrier to purchase.
An online survey, conducted by Asthma Foundation NSW during April 2012, which collected information about 859 adults with asthma, inspired the study. It found:
- 85% of respondents had an issue with the cost of their medication, with 38% finding it is usually or always an issue.
- 49% of respondents admitted to taking less medication, or going without entirely, because of the cost.
- When people were skipping medications, 81% were not taking preventer medication, 26% not taking reliever and 7% not taking respiratory meds such as oral steroids.
- Over 75% of people who said they always or usually went without medications due to cost reported that there had been an asthma attack as a result. In more than half of these cases, urgent medical help (GP or hospital) was required.
A core focus of the study will be exploring at what price points asthma preventer medications will be more affordable for people, through a process called ‘discrete choice experimentation’.
The study will also focus on current prescriptions of combination inhaled corticosteroids (ICS)/long-acting beta2-agonist (LABA) preventers which are prescribed by Australian GPs in 89% of cases. Asthma guidelines advise that the ICS/LABA combination should be reserved for patients whose asthma is not well controlled on low or moderate doses of ICS. Clinical trials show that approximately 70% of adults with asthma can achieve good control on ICS alone.[iii]
“Although the ICS/LABA combination is effective for people with poorly controlled asthma, there is no evidence that patients who are well controlled on ICS alone gain any health benefit from the addition of LABA,” said Goldman.
Combination therapy now represents over 40% of prescribed preventer therapy in children, exceeding current guidelines which suggest combination therapy should represent no more than 10% of prescribed preventer therapy in children and probably less, given the availability of alternative options.[iv]
Given that the ICS/LABA combination is up to 2.8 times more expensive to the government than ICS alone, it represents a significant portion of the total asthma health budget of $655m per annum, 50% of which is spent on medications.
“We’d like to turn a win into a win-win by making a strong case for the government to use those PBS savings to lower the cost of some preventer medications and reduce long-term health costs.
“Reducing health costs is a universal challenge and we hope this study will not only produce savings, but better long-term health outcomes through cheaper asthma medications,” said Goldman.
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