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Original Research: COPD |

Inhaler Costs and Medication Nonadherence Among Seniors With Chronic Pulmonary Disease

Peter J. Castaldi, MD; William H. Rogers, PhD; Dana Gelb Safran, ScD; Ira B. Wilson, MD
Author and Funding Information

From the Institute for Clinical Research and Health Policy Studies (Drs Castaldi, Rogers, Safran, and Wilson), Tufts Medical Center; and Blue Cross Blue Shield of Massachusetts (Dr Safran), Boston, MA.

Correspondence to: Peter J. Castaldi, MD, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA 02111; e-mail: pcastaldi@tuftsmedicalcenter.org


Funding/Support: This work was funded by a grant from the Agency for Healthcare Research and Quality [Grant 5R01HS009622], the National Institutes of Health [Grants T32HS00060, F32 HL094035], and the National Center for Research Resources [Tufts CTSA, Grant 5UL1RR025752].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):614-620. doi:10.1378/chest.09-3031
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Background:  Chronic pulmonary diseases (CPDs) such as asthma and COPD are associated with particularly high rates of cost-related medication nonadherence (CRN), but the degree to which inhaler costs contribute to this is not known. Here, we examine the relationship between inhaler-specific out-of-pocket costs and CRN in CPD.

Methods:  Using data obtained in 2006 in a national stratified random sample (N = 16,072) of community-dwelling Medicare beneficiaries aged ≥ 65 years, we used logistic regression to examine the relationship between inhaled medications, various types of out-of-pocket costs, and CRN in persons with CPD.

Results:  The prevalence of CRN in Medicare recipients with CPD using inhalers was 31%. In multivariate models, the odds that respondents with CPD using inhalers would report CRN was 1.43 (95% CI, 1.21-1.69) compared with respondents without CPD who were not using inhalers. Adjustment for out-of-pocket inhaler costs—but not adjustment for total medication costs or non-inhaler costs—eliminated this excess risk of CRN (OR, 0.95; 95% CI, 0.71-1.28). Patients paying > $20 per month for inhalers were at significantly higher risk for CRN compared with those who had no out-of-pocket inhaler costs.

Conclusions:  Individuals with CPD and high out-of-pocket inhaler costs are at increased risk for CRN relative to individuals on other medications. Physicians should be aware that inhalers can pose a particularly high risk of medication nonadherence for some patients.

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