Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis

Authors

Tracey Laba, University of Sydney, University of New South Wales
Helen K. Reddel, University of Sydney
Nicholas Arnold Zwar, University of New South Wales, University of WollongongFollow
Guy B. Marks, University of New South Wales, University of Sydney
Elizabeth Roughead, University of South Australia
Anthony Flynn, Asthma Australia Ltd
Michele Goldman, Asthma Australia LtdFollow
Aine Heaney, NPS MedicineWise
Kirsty Lembke, NPS MedicineWise
Stephen Jan, University of New South Wales

RIS ID

131614

Publication Details

Laba, T., Reddel, H. K., Zwar, N. J., Marks, G. B., Roughead, E., Flynn, A., Goldman, M., Heaney, A., Lembke, K. & Jan, S. (2019). Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis. PharmacoEconomics, 37 (2), 227-238.

Abstract

Background: In Australia, many patients who are initiated on asthma controller inhalers receive combination inhaled corticosteroid/long-acting beta₂-agonist (ICS/LABA) despite having asthma of sufficiently low severity that ICS-alone would be equally effective and less costly for the government.

Methods: We conducted a discrete choice experiment (DCE) in a nationally representative sample of adults (n = 792) and parents of children (n = 609) with asthma. Mixed multinomial models were estimated and calibrated to reflect the estimated market shares of ICS-alone, ICS/LABA and no controller. We then simulated the impact of varying patient co-payment on demand and the financial impact on government pharmaceutical expenditure.

Results: Preference for inhaler decreased with increasing costs to the patient or government, increasing chance of a repeat visit to the doctor, and if fewer symptoms were present. Adults preferred high-strength controllers, but parents preferred low-strength inhalers for children (general beneficiaries only). The DCE predicted a higher proportion choosing controller treatment (89%) compared to current levels (57%) at the current co-payment level, with proportionately higher uptake of ICS-alone and a lower average cost per patient [32.73 Australian dollars (AU$) c.f. AU$38.54]. Reducing the co-payment on ICS-alone by 50% would increase its market share to 50%, whilst completely removing the co-payment would only have a small marginal impact on market share, but increased average cost of treatment to the government to AU$41.04 per person.

Conclusions: Patient-directed financial incentives are unlikely to encourage much switching of medicines, and current levels of under-treatment are not explained by patient preferences. Interventions directed at prescribers are more likely to promote better use of asthma medicines.