Impact of changes to reimbursement of fixed combinations of inhaled corticosteroids and long-acting β₂ -agonists in obstructive lung diseases: a population-based, observational study.

• Published in: International Journal of Clinical Practice
• Main Authors: Björnsdóttir, U S, Sigurðardóttir, S T, Jonsson, J S, Jonsson, M, Telg, G, Thuresson, M, Naya, I, Gizurarson, S
• Other Authors: Faculty of Medicine, Landspitali-The National University Hospital of Iceland, University of Iceland, Norurmýri, 101, Reykjavík, Iceland b Department of Immunology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland c Heilsugæslan Gardabaer, Gardabaer, Iceland
• Format: Article in Journal/Newspaper
• Language: English
• Published: John Wiley & Sons 2014
• Subjects: Lungnasjúkdómar; Asma; Lyfjakostnaður; Lyfjanotkun; Sjúkratryggingar; Pulmonary Disease; Chronic Obstructive/drug therapy*; Adrenal Cortex Hormones; Iceland; Health Policy; Insurance; Health; Reimbursement; Cost Control; Asthma; Drug Costs; Health Care Costs/legislation and jurisprudence; Saba
• Online Access: http://hdl.handle.net/2336/326054; https://doi.org/10.1111/ijcp.12473

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access. In 2010, the Icelandic government introduced a new cost-saving policy that limited reimbursement of fixed inhaled corticosteroid/long-acting β₂ -agonist (ICS/LABA) combinations. This population-based, retrospective, observational study assessed the effects of this policy change by linking specialist/primary care medical records with data from the Icelandic Pharmaceutical Database. The policy change took effect on 1 January 2010 (index date); data for the year preceding and following this date were analysed in 8241 patients with controlled/partly controlled asthma and/or chronic obstructive pulmonary disease (COPD) who had been dispensed an ICS/LABA during 2009. Oral corticosteroid (OCS) and short-acting β₂ -agonist (SABA) use, and healthcare visits, were assessed pre- and post-index. The ICS/LABA reimbursement policy change led to 47.8% fewer fixed ICS/LABA combinations being dispensed during the post-index period among patients whose asthma and/or COPD was controlled/partly controlled during the pre-index period. Fewer ICS monocomponents were also dispensed. A total of 48.6% of patients were no longer receiving any respiratory medications after the policy change. This was associated with reduced disease control, as demonstrated by more healthcare visits (44.0%), and more OCS (76.3%) and SABA (51.2%) dispensations. Overall, these findings demonstrate that changes in healthcare policy and medication reimbursement can directly impact medication use and, consequently, clinical outcomes and should, therefore, be made cautiously. AstraZeneca