Holly McCabe1, Brian Godman2,3,4, Amanj Kurdi2,5, Katie Johnston6, Sean MacBride-Stewart7, Janey Lennon7, Simon Hurding8, Marion Bennie2, Alec Morton1. 1. a Department of Management Science , Strathclyde Business School, University of Strathclyde , Glasgow , UK. 2. b Strathclyde Institute of Pharmacy and Biomedicial Sciences , University of Strathclyde , Glasgow , UK. 3. c Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital , Huddinge , Sweden. 4. d Department of Public Health Pharmacy and Management , School of Pharmacy, Sefako Makgatho Health Sciences University , Garankuwa , South Africa. 5. e Department of pharmacology , College of Pharmacy, Hawler Medical University , Erbil , Iraq. 6. f Prescribing Advisor Primary Care , NHS , Edinburgh , UK. 7. g Pharmacy Service , NHS Greater Glasgow and Clyde , Glasgow , UK. 8. h Therapeutics Branch , Scottish Government , Edinburgh , UK.
Abstract
Background: There is an increasing prevalence of asthma and chronic obstructive pulmonary disease (COPD) worldwide, leading to increased inhaler use. However, there are concerns with inhaler compliance resulting in different patented inhalers and longer-acting formulations. As a result, inhalers are now among the highest expenditure items in ambulatory care in Scotland leading to multiple initiatives to keep within budget without compromising care. Method: This study assesses inhaler utilization and expenditure between 2001 and 2017 alongside health authority initiatives. Results: There was an increase by 137% in inhaler utilization between 2001 and 2017, and a two-fold increase in expenditure, driven by the increasing use of patented combination inhalers to address concerns. This is very different to the oral markets where expenditure on proton pump inhibitors, statins, and antihypertensives have fallen considerably recently despite increased volumes due to the increasing use of low-cost generics. However, inhaler expenditure has started to fall with an increasing use of lower cost combinations and initiatives to reduce the steroid burden alongside monitoring patient care. Conclusion: Challenges with using and changing inhalers has meant this market has not followed other high-volume drug classes following patent loss. This is starting to change, with the situation monitored to enhance efficient prescribing alongside continued good quality care.
Background: There is an increasing prevalence of asthma and chronic obstructive pulmonary disease (COPD) worldwide, leading to increased inhaler use. However, there are concerns with inhaler compliance resulting in different patented inhalers and longer-acting formulations. As a result, inhalers are now among the highest expenditure items in ambulatory care in Scotland leading to multiple initiatives to keep within budget without compromising care. Method: This study assesses inhaler utilization and expenditure between 2001 and 2017 alongside health authority initiatives. Results: There was an increase by 137% in inhaler utilization between 2001 and 2017, and a two-fold increase in expenditure, driven by the increasing use of patented combination inhalers to address concerns. This is very different to the oral markets where expenditure on proton pump inhibitors, statins, and antihypertensives have fallen considerably recently despite increased volumes due to the increasing use of low-cost generics. However, inhaler expenditure has started to fall with an increasing use of lower cost combinations and initiatives to reduce the steroid burden alongside monitoring patient care. Conclusion: Challenges with using and changing inhalers has meant this market has not followed other high-volume drug classes following patent loss. This is starting to change, with the situation monitored to enhance efficient prescribing alongside continued good quality care.
Entities:
Keywords:
Asthma; COPD; Scottish NHS; drug utilisation; expenditure; inhalers; reforms
Authors: Brian Godman; Magdalene Wladysiuk; Stuart McTaggart; Amanj Kurdi; Eleonora Allocati; Mihajlo Jakovljevic; Francis Kalemeera; Iris Hoxha; Anna Nachtnebel; Robert Sauermann; Manfred Hinteregger; Vanda Marković-Peković; Biljana Tubic; Guenka Petrova; Konstantin Tachkov; Juraj Slabý; Radka Nejezchlebova; Iva Selke Krulichová; Ott Laius; Gisbert Selke; Irene Langner; András Harsanyi; András Inotai; Arianit Jakupi; Svens Henkuzens; Kristina Garuolienė; Jolanta Gulbinovič; Patricia Vella Bonanno; Jakub Rutkowski; Skule Ingeberg; Øyvind Melien; Ileana Mardare; Jurij Fürst; Sean MacBride-Stewart; Carol Holmes; Caridad Pontes; Corinne Zara; Marta Turu Pedrola; Mikael Hoffmann; Vasileios Kourafalos; Alice Pisana; Rita Banzi; Stephen Campbell; Bjorn Wettermark Journal: Biomed Res Int Date: 2021-10-11 Impact factor: 3.411