title: Inhaler costs and medication nonadherence among seniors with chronic pulmonary disease.
abstract: 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 >or= 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.
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA. pcastaldi@tuftsmedicalcenter.org
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Castaldi
authors.forename: William H
authors.initials: WH
authors.lastname: Rogers
authors.forename: Dana Gelb
authors.initials: DG
authors.lastname: Safran
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016527:Drug Costs; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008297:Male; D055118:Medication Adherence; D009330:Nebulizers and Vaporizers / Q000191:economics*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D019141:Respiratory System Agents / Q000008:administration & dosage / Q000191:economics*; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D019141:Respiratory System Agents