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Effect of cost-sharing on use of asthma medication in children
Wendy J Ungar1, Anita Kozyrskyj, Michael Paterson
1Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada. wendy.ungar@sickkids.ca
Insights
Higher cost-sharing for asthma medications significantly reduced medication use in children. This highlights financial barriers to essential asthma treatments, impacting adherence and potentially disease control.
Area of Science:
- Pediatric Asthma Management
- Health Economics
- Pharmaceutical Access
Background:
- Asthma guidelines recommend multiple medications for optimal control in children.
- Cost-sharing in drug benefit plans can create barriers to accessing prescribed asthma medications.
- Understanding these financial barriers is crucial for improving pediatric asthma care.
Purpose of the Study:
- To investigate the impact of varying cost-sharing levels on the utilization of asthma medications among children.
- To determine if out-of-pocket expenses influence the purchase of controller and reliever asthma drugs.
Main Methods:
- A population-based retrospective cohort study analyzed administrative insurance claims data for 17,046 children with asthma in Ontario, Canada.
- Children were categorized into zero, low (<20%), or high (>=20%) cost-sharing groups based on out-of-pocket expenses and reimbursements.
- Medication use (bronchodilators, inhaled corticosteroids, leukotriene receptor antagonists, oral corticosteroids, combination agents) was compared using regression analyses, controlling for age and sex.
Main Results:
- Children in the high cost-sharing group had significantly fewer annual asthma medication claims (6.6) compared to zero (7.0) and low (7.2) cost-sharing groups.
- High cost-sharing was associated with a lower likelihood of purchasing bronchodilators, inhaled corticosteroids, and leukotriene receptor antagonists (OR 0.76).
- Dual agent use was also significantly lower in the high cost-sharing group compared to the low cost-sharing group (OR 0.70).
Conclusions:
- Cost-sharing levels demonstrably influence asthma medication use in children.
- The highest cost-sharing group showed significantly reduced use of maintenance medications and newer combination therapies.
- Financial burden associated with asthma medications presents a barrier to adherence and potentially optimal asthma control in pediatric populations.
Objective:
To examine the effect of cost-sharing on the use of asthma medications in asthmatic children. According to asthma guidelines, children with asthma may require treatment with multiple medications, including controllers and relievers, to achieve optimal control. Although families may be enrolled in drug benefit plans, impediments to access persist in the form of cost-sharing.
Design:
Population-based retrospective cohort study of children by analysis of administrative medication insurance claims data.
Setting:
Ontario, Canada.
Participants:
A cohort of 17 046 Ontario children with asthma enrolled in private drug plans. Main Exposure We used data on out-of-pocket expenses and reimbursement for medications to classify children as having zero, low (< 20%), or high (> or = 20%) levels of cost-sharing.
Main Outcome Measures:
We examined use of bronchodilators, inhaled corticosteroids, leukotriene receptor antagonists, oral corticosteroids, and combination agents. Multiple linear and logistic regressions compared medication use between cost-sharing groups, controlling for age and sex.
Results:
The annual number of asthma medication claims per child was significantly lower in the high cost-sharing group (6.6) compared with the zero (7.0) and low (7.2) cost-sharing groups (P < .001). Children in the high cost-sharing group were less likely to purchase bronchodilators, inhaled corticosteroids, and leukotriene receptor antagonists compared with the low cost-sharing group (odds ratio, 0.76; 95% confidence interval, 0.67-0.86) and were less likely to purchase dual agents compared with the low cost-sharing group (odds ratio, 0.70; 95% confidence interval, 0.66-0.75).
Conclusion:
The cost-sharing level affected the use of asthma medication, with the highest cost-sharing group exhibiting significantly lower use of maintenance medications and newer dual agents.
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