PharmacoEconomics & Outcomes News 651 - 14 Apr 2012

Cost sharing of antiasthmatics inchildren – is it really worth it?

Greater cost sharing for antiasthmatic medications isassociated with a "slight reduction in medication use andhigher rates of asthma hospitalisation" in children aged5–18 years with newly-diagnosed, persistent asthmainitiating long-term control therapy in the USA,according to the authors of a study published in theJAMA.1

They retrospectively analysed longitudinal privateinsurance data from 1997–2008 to investigate theassociation of out-of-pocket asthma medication costswith medication usage and asthma-related emergencydepartment (ED) and hospitalisation visits in the 1 yearafter initiation of therapy. Of the 8834 included patients,2921 were aged < 5 years and 5913 wereaged 5–18 years.

The mean annual out-of-pocket medication costswere $US154 and $151 in children aged 5-18 years and< 5 years, respectively. In the older patient group, filledasthma prescriptions covered a mean 41% of days,and 2.1% and 3.7% had an asthma-relatedhospitalisation and ED visit, respectively. Thecorresponding figures in the younger patient group were46%, 4.7% and 7.9%. The adjusted medication use in theolder patient group decreased from 41.7% to 40.3%(p < 0.05) when the out-of patient costs were increasedfrom the 25th to the 75th percentile, but no changeswere seen in the younger group. The adjusted asthma-related hospitalisations were again higher in the oldergroup in patients who were in the top quartile of out-ofpocket costs versus patients in the bottom quartile(2.4 vs 1.7 hospitalisations per 100 patients; p < 0.01)but not in the younger group. The rate of ED visits didnot vary across out-of-pocket cost quartiles for eitherpatient group.

Should cost sharing remain low?In an accompanying editorial, Wendy Ungar from the

University of Toronto (ON, Canada), says that "cost-sharing levels of necessary drugs need to remain low soas not to deter acquisition and shift program costs tofamilies".2 She continues by saying that fully coveringinterventions and services that promote child health anddeter or even prevent diseases in adult patients "isperhaps the best form of value in drug policy reform".1. Karaca-Mandic P, et al. Out-of-pocket medication costs and use of medications

and health care services among children with asthma. JAMA: the Journal of theAmerican Medical Association 307: 1284-91, No. 12, 28 Mar 2012. Availablefrom: URL: http://dx.doi.org/10.1001/jama.2012.340.

2. Ungar WJ. Medication cost sharing and health outcomes in children withasthma. JAMA: the Journal of the American Medical Association 307: 1316-8,No. 12, 28 Mar 2012. Available from: URL: http://dx.doi.org/10.1001/jama.2012.365.

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PharmacoEconomics & Outcomes News 14 Apr 2012 No. 6511173-5503/10/0651-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved