Back to Journals » Pragmatic and Observational Research » Volume 8

Does co-payment for inhaler devices affect therapy adherence and disease outcomes? A historical, matched cohort study

Authors Voorham J, Vrijens B, van Boven JFM, Ryan D, Miravitlles M, Law LM, Price DB

Received 18 January 2017

Accepted for publication 7 March 2017

Published 18 April 2017 Volume 2017:8 Pages 31—41


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Dr John Haughney

Jaco Voorham,1 Bernard Vrijens,2 Job FM van Boven,3,4 Dermot Ryan,5 Marc Miravitlles,6 Lisa M Law,1 David B Price1,7

1Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore; 2Department of Public Health Sciences, Faculty of Medicine, University of Liège, Liège, Belgium; 3Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, 4Department of General Practice, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; 5Allergy and Respiratory Research Group, University of Edinburgh, Edinburgh, UK, 6Department of Pulmonology, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain; 7Academic Primary Care, The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

Background: Adherence to asthma and chronic obstructive pulmonary disease (COPD) treatment has been shown to depend on patient-level factors, such as disease severity, and medication-level factors, such as complexity. However, little is known about the impact of prescription charges – a factor at the health care system level. This study used real-life data to investigate whether co-payment affects adherence (implementation and persistence) and disease outcomes in patients with asthma or COPD.
A matched, historical cohort study was carried out using two UK primary care databases. The exposure was co-payment for prescriptions, which is required for most patients in England but not in Scotland. Two comparison cohorts were formed: one comprising patients registered at general practices in England and the other comprising patients registered in Scotland. Patients aged 20–59 years with asthma, or 40–59 years with COPD, who were initiated on fluticasone propionate/salmeterol xinafoate, were included, matched to patients in the opposite cohort, and followed up for 1 year following fluticasone propionate/salmeterol xinafoate initiation. The primary outcome was good adherence, defined as medication possession ratio ≥80%, and was analyzed using conditional logistic regression. Secondary outcomes included exacerbation rate.
There were 1,640 patients in the payment cohort, ie, England (1,378 patients with asthma and 262 patients with COPD) and 619 patients in the no-payment cohort, ie, Scotland (512 patients with asthma and 107 patients with COPD). The proportion of patients with good adherence was 34.3% and 34.9% in the payment and no-payment cohorts, respectively, across both disease groups. In a multivariable model, no difference in odds of good adherence was found between the cohorts (odds ratio, 1.04; 95% confidence interval, 0.85–1.27). There was also no difference in exacerbation rate.
Conclusion: There was no difference in adherence between matched patients registered in England and Scotland, suggesting that prescription charges do not have an impact on adherence to treatment.

Keywords: implementation, adherence, asthma, chronic obstructive pulmonary disease, prescriptions, co-payment

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]


Other articles by this author:

Seasonal patterns of oral antihistamine and intranasal corticosteroid purchases from Australian community pharmacies: a retrospective observational study

Carney AS, Price DB, Smith PK, Harvey R, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner DA, Carter V, Durieux AMS

Pragmatic and Observational Research 2017, 8:157-165

Published Date: 30 August 2017

Asthma referrals: a key component of asthma management that needs to be addressed

Price D, Bjermer L, Bergin DA, Martinez R

Journal of Asthma and Allergy 2017, 10:209-223

Published Date: 25 July 2017

Cardiovascular risks in smokers treated with nicotine replacement therapy: a historical cohort study

Dollerup J, Vestbo J, Murray-Thomas T, Kaplan A, Martin RJ, Pizzichini E, Pizzichini MMM, Burden A, Martin J, Price DB

Clinical Epidemiology 2017, 9:231-243

Published Date: 26 April 2017

An evaluation of exact matching and propensity score methods as applied in a comparative effectiveness study of inhaled corticosteroids in asthma

Burden A, Roche N, Miglio C, Hillyer EV, Postma DS, Herings RMC, Overbeek JA, Khalid JM, van Eickels D, Price DB

Pragmatic and Observational Research 2017, 8:15-30

Published Date: 22 March 2017

The use of multiple respiratory inhalers requiring different inhalation techniques has an adverse effect on COPD outcomes

Bosnic-Anticevich S, Chrystyn H, Costello RW, Dolovich MB, Fletcher MJ, Lavorini F, Rodríguez-Roisin R, Ryan D, Wan Yau Ming S, Price DB

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:59-71

Published Date: 21 December 2016

Predicting frequent COPD exacerbations using primary care data

Kerkhof M, Freeman D, Jones R, Chisholm A, Price DB

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2439-2450

Published Date: 9 November 2015

The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK

Brusselle G, Price D, Gruffydd-Jones K, Miravitlles M, Keininger DL, Stewart R, Baldwin M, Jones RC

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2207-2217

Published Date: 15 October 2015

Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD

Postma DS, Roche N, Colice G, Israel E, Martin RJ, van Aalderen WMC, Grigg J, Burden A, Hillyer EV, von Ziegenweidt J, Gopalan G, Price D

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:1163-1186

Published Date: 17 October 2014

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

Price D, West D, Brusselle G, Gruffydd-Jones K, Jones R, Miravitlles M, Rossi A, Hutton C, Ashton VL, Stewart R, Bichel K

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:889-905

Published Date: 27 August 2014

Impact of night-time symptoms in COPD: a real-world study in five European countries

Price D, Small M, Milligan G, Higgins V, Garcia Gil E, Estruch J

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:595-603

Published Date: 27 November 2013