Financial Burden Due to Oversupply of the Combined Inhaler of Corticosteroid and Long-acting Beta-agonist (LABA) in Outpatients at Songklanagarind Hospital

Abstract

Objectives:  To estimate the prevalence of patients with oversupply of inhaled corticosteroid and long-acting beta2-agonists (ICS/LABA) combination including fluticasone/salmeterol (125/25), fluticasone/salmeterol (100/50), flutica sone/salmeterol (250/50) and budesonide/formoterol (160/4.5), and to determine financial loss due to oversupply. Methods: The study employed the data in outpatient database of Songklanagarind Hospital during April 1, 2016 to December 31, 2017. Definition of oversupply in the study was having prescribed inhalers exceeding the needed amount more than one canister within the study duration over 21 months. Results: 2,414 patients were included in the study. The prevalences of oversupply in the patients receiving fluticasone/salmeterol (125/25), fluticasone/salmeterol (100/50), fluticasone/salmeterol (250/50), and budesonide/formoterol (160/4.5) were 331 cases (34.34%), 12 cases (1.21%), 146 cases (20.28%), and 161 cases (21.41%), respectively. The financial loss incurred due to oversupply of four ICS/LABA inhalers was 821,609 Baht in the study period. Patients with the civil servant medical benefits scheme and those receiving care from general medicine clinic had the highest prevalence of medication oversupply (71.73% and 34.89%, respectively). Conclusions: Development of system for aiding prescribing decision is warrant, for example the system indicating, in each prescribing, the accumulated medication amount prescribed in the past and the needed amount of medication. Appropriate measure would save medication cost for approximately 460,000 Baht per year.