Cost saving of switching to equivalent inhalers and its effect on health outcomes

Abstract

BackgroundSwitching inhalers to cheaper equivalent products is often advocated as a necessary cost saving measure, yet the impact on patient’s health and healthcare utilisation has not been measured.MethodsWe identified asthma and chronic obstructive pulmonary disease (COPD) patients from UK primary care electronic healthcare records between 2000 and 2016. A self-controlled case series was used to estimate incidence rate ratios (IRR); comparing outcome rates during the risk period, 3 months after the exposure (financially motivated switch), and control periods (preswitch and postrisk period). Four outcomes were assessed: disease exacerbation, general practitioner consultation, non-specific respiratory events and adverse-medication events. Medication possession ratio (MPR) was calculated to assess adherence. 2017 National Health Service indicative prices were used to estimate cost differences per equivalent dose.ResultsWe identified a cohort of 569 901 asthma and 171 231 COPD regular inhaler users, 2% and 6% had been switched, respectively. Inhaler switches between a brand-to-generic inhaler, and all other switches (brand-to-brand, generic-to-generic, generic-to-brand), were associated with reduced exacerbations (brand-to-generic: IRR=0.75, 95% CI 0.64 to 0.88; all other: IRR=0.79, 95% CI 0.71 to 0.88). Gender, age, therapeutic class, inhaler device and inhaler-technique checks did not significantly modify this association (p<0.05). The rate of consultations, respiratory-events and adverse-medication events did not change significantly (consultations: IRR=1.00, 95% CI 0.99 to 1.01; respiratory-events: IRR=0.96, 95% CI 0.95 to 0.97; adverse-medication-events: IRR=1.05, 95% CI 0.96 to 1.15). Adherence significantly increased post-switch (median MPR: pre-switch=54%, post-switch=62%; p<0.001). Switching patients, in the cohort of regular inhaler users, to the cheapest equivalent inhaler, could have saved around £6 million annually.ConclusionSwitching to an equivalent inhaler in patients with asthma or COPD appeared safe and did not negatively affect patient’s health or healthcare utilisation.

Environmental impact of inhalers for respiratory diseases: decreasing the carbon footprint while preserving patient-tailored treatment

“…Switching inhalers can be considered safe, if implemented correctly, which should include appropriate patient selection and mandating the importance of providing inhaler education. 17 However, other papers report that non-consensual switches can result in patient discontent, reduced confidence in the medication, and uncertainty regarding the degree of disease control and therefore it is recommended that patients with stable disease remain on their current device. 18 Approaches to more sustainable solutions should therefore effectively balance environmental goals with patient health while maintaining a diverse range of therapeutic choices which allow patients and healthcare professionals to select the most appropriate medicationdevice combination.…”

Health and cost impact of stepping down asthma medication for UK patients, 2001–2017: A population-based observational study

“…Interestingly, there was a slight reduction in exacerbations when stepping down ICSs not seen when stepping down add-on therapies. This could be explained by confounding by indication from an unmeasured variable that led to patient selection only in patients with ICS overtreatment or could be due to increased adherence after medication change from increased medication awareness [39].…”

Switching Inhalers: A Practical Approach to Keep on UR RADAR

“…Exact switching rates differ per type of drug, disease, country and health plan. For example, in the Netherlands, a monthly median of 7% of salbutamol users switched between inhalers during the period 2009-2016 [9], while in the United Kingdom, inhaler switching rates were between 2 and 6% for asthma and COPD, respectively, over the period 2000-2016 [10]. Of note, contrasting with oral therapies such as tablets or capsules, most of the inhaler switches involve a completely different device with its own characteristics, administration and handling technique.…”