Asthma remedy step-downs may reduce costs without compromising health

While international guidelines for treating asthma recommend that clinicians find the lowest effective dose that can control their symptoms, patients with asthma are being prescribed higher and higher doses of the drug. Published in PLOS medicine A study by Dr. Chloe Bloom at Imperial College in London, United Kingdom, found that lowering drug doses did not increase asthma exacerbations, but could significantly reduce drug costs.

More than 5.4 million people in the UK are treated for asthma, and asthma medications account for 13% of primary care prescription costs. In addition, long-term use and high doses of asthma medications increase the risk of systemic side effects and the cost of treatment. To understand symptoms, diagnoses, and prescribing patterns, researchers conducted a population-based observational study on primary care electronic medical records of 508,459 asthma patients treated in the United Kingdom between 2001 and 2017. I accessed. The Clinical Asthma Code was then used to assess a cohort of regular asthma prophylaxis users, and changes in prescribed asthma medications and subsequent health outcomes were analyzed for 31379 patients who stopped prescribing asthma medications. did. We then used the 2019 drug cost to calculate the cost impact of drug reduction in the cohort.

Inhaled corticosteroids (ICS) are the second most prescribed drug, suggesting that proper demotion of asthma patients could result in significant cost savings. In addition, demoting just half of all eligible patients taking a long-acting beta agonist (LABA) will save about £17 million, or 2% of the UK asthma budget. This study is only the second real-world study comparing patients with blood pressure and controls. One of the major strengths is the inclusion of a nationally representative study population and large sample size. However, researchers have had a limited ability to track which prescribed drugs have been dispensed and complied with. This may be an important issue for future research.

According to the authors, “treatment step-downs are recommended by clinical guidelines but found to occur infrequently. ICS or add-on therapy step-downs did not appear to worsen health outcomes.” But it seemed to lead to significant cost savings.”

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Funding: The author has not received any special funding for this work.

Competing Stakeholders: I have read the journal policy, and the authors of this manuscript have the following competing stakeholders. The CIB reports non-work financial support provided by Asthma, Chiesi, and AstraZeneca in the UK. In addition to the submitted research, the AS reports that his institution received research support from the Asthma UK for the Asthma UK Center for Applied Research. AS is a member of the editorial board PLOS medicine.. JKQ reports grants from MRC, GSK, BLF, Asthma UK, The Health Foundation, IQVIA, AstraZeneca, Chiesi, BI and Bayer. Personal fees from AZ, Chiesi, BI, Bayer, and TEVA other than the submitted work. The LDP has not declared any competing interests related to this manuscript.

Source: Bloom CI, de Preux L, Sheikh A, Quint JK (2020) Health and cost impact of step-downs of asthma medications for UK patients, 2001-2017: A population-based observational study. PLoS Med 17 (7): e1003145. https://Doi.org/Ten.1371 /journal.pmed.1003145

Author affiliation: Imperial College London, UK; University of Edinburgh, UK

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