Stepping-down asthma medication may significantly reduce costs without increasing adverse health outcomes
Study suggests that many clinicians may prescribe higher levels of treatment than is clinically indicated
International guidelines for asthma treatment recommend clinicians find the minimum effective dose that can control symptoms, yet asthma patients are increasingly prescribed high doses of medication. A study published in PLOS Medicine by Chloe Bloom at Imperial College London and colleagues found that stepping-down medication doses did not increase asthma exacerbations and could significantly reduce medication costs.
Over 5.4 million people receive asthma treatment in the United Kingdom and asthma medication comprises 13% of total primary care prescribing costs. Additionally, prolonged use and higher doses of asthma medications are associated with a higher risk for systemic adverse effects and high medication costs. To understand the symptoms, diagnoses, and prescription patterns, researchers conducted a population-based observational study, accessing primary care electronic health records of 508,459 asthma patients treated in the United Kingdom between 2001-2017. Using clinical asthma codes, researchers then evaluated a cohort of regular asthma preventer users, analysing changes in prescribed asthma medications and subsequent health outcomes for 31,379 patients who were stepped-down in their asthma medicine prescriptions. The cost impact of medication stepped-down was then calculated for the cohort using 2019 drug costs.
Inhaled corticosteroids (ICS) are the second most prescribed medication, suggesting the potential to reduce costs considerably with appropriate stepping-down among asthma patients. Additionally, stepping-down prescriptions for long-acting β agonist (LABA) medication may save around £28 million, equivalent to 3.5% of the UK’s asthma budget. This research is only the second real-world study to compare stepped-down patients to controls and one of the major strengths is inclusion of a nationally representative study population and large sample size. However, the researchers were limited in their ability to track which prescribed medications were dispensed and adhered to, a question that may be important for future studies.
According to the authors, “Although stepping-down of treatment is recommended by clinical guidelines, we found that it happened infrequently. Stepping-down ICS or add-on therapy did not appear to worsen health outcomes but did appear to result in significant cost savings.”