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Cost considerations of therapeutic options for children with asthma
1Respiratory Department, Sydney Childrens Hospital, Randwick, Sydney, NSW, Australia. Sandra.chuang@sesiahs.health.nsw.gov.au
Insights
Inappropriate prescribing of expensive asthma inhalers like ICS/LABA combinations in children is common, despite guidelines. Cost-effective prescribing is crucial for better asthma management and reduced healthcare spending.
Area of Science:
- Pediatric Pulmonology
- Health Economics
- Pharmacotherapy
Background:
- Childhood asthma presents significant economic burdens on individuals, families, and national healthcare systems.
- Pharmaceutical costs, particularly for inhaled corticosteroids (ICS) and ICS/long-acting beta-agonist (LABA) combinations, are major drivers of asthma-related healthcare expenditure.
- Current asthma management guidelines are not effectively preventing inappropriate prescribing practices.
Purpose of the Study:
- To evaluate the appropriateness of inhaled corticosteroid (ICS) and ICS/long-acting beta-agonist (LABA) combination inhaler prescribing in children with asthma.
- To identify patterns of inappropriate medication use and their potential economic implications.
- To emphasize the importance of cost-effective prescribing strategies in pediatric asthma management.
Main Methods:
- Review of prescribing data for inhaled corticosteroids (ICS) and ICS/long-acting beta-agonist (LABA) combination inhalers in pediatric asthma patients.
- Analysis of prescribing trends in relation to asthma severity, patient age, and prior medication use.
- Assessment of adherence to established asthma management guidelines.
Main Results:
- Significant inappropriate prescribing of ICS and ICS/LABA inhalers, including high-dose ICS without specialist consultation.
- Increased prescription rates of ICS/LABA inhalers despite decreasing asthma prevalence and inappropriate use in children under 5.
- Costly ICS/LABA inhalers initiated in patients not previously on ICS, indicating potential non-adherence to stepwise treatment.
Conclusions:
- Inappropriate prescribing of ICS/LABA combination inhalers in children is a significant issue, contributing to increased healthcare costs.
- Adherence to guidelines for appropriate asthma medication use, particularly for ICS/LABA inhalers, is essential.
- Promoting cost-effective prescribing practices is vital for optimizing pediatric asthma management and reducing financial burdens.
Abstract:
Asthma is a prevalent health condition in children, with economic implications for the individual and their family, as well as for societies with nationalized healthcare. Pharmaceutical cost is the main driver of healthcare expenditure in asthma. Existent explicit guidelines are meant to guide asthma management across all age groups, but they are failing. Pharmacologic management of asthma consists of a stepwise treatment approach to achieve symptom control. Various studies suggest a significant number of medical practitioners are prescribing inhaled corticosteroids (ICS) and ICS/long-acting beta agonist (LABA) combination inhalers inappropriately, including prescribing high doses of ICS without specialist consultation. ICS/LABA combination inhalers should only be used in persistent asthmatics, which account for approximately 5% of all children with asthma. Despite this, there is an increase in prescribing rates of ICS/LABA combination inhalers in the context of a decrease in the prevalence of asthma. Furthermore, there is inappropriate prescribing of ICS/LABA combination inhalers in children under 5 years of age, and initiation of relatively more expensive ICS/LABA combination inhalers in patients who have not previously been prescribed ICS. There is evidence to suggest that cost is a significant barrier to asthma management, especially for the more expensive ICS/LABA combination inhalers. Hence, prescribing cost-effective asthma medications appropriately is one of the most important strategies in reducing the morbidity and mortality associated with asthma. It is incumbent on every medical practitioner to not prescribe expensive medications if not indicated, both for the sake of the patient and for society.
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