title: Impact of changes to reimbursement of fixed combinations of inhaled corticosteroids and long-acting β₂ -agonists in obstructive lung diseases: a population-based, observational study.
abstract: BACKGROUND
  In 2010, the Icelandic government introduced a new cost-saving policy that limited reimbursement of fixed inhaled corticosteroid/long-acting β₂ -agonist (ICS/LABA) combinations.
  
  
  METHODS
  This population-based, retrospective, observational study assessed the effects of this policy change by linking specialist/primary care medical records with data from the Icelandic Pharmaceutical Database. The policy change took effect on 1 January 2010 (index date); data for the year preceding and following this date were analysed in 8241 patients with controlled/partly controlled asthma and/or chronic obstructive pulmonary disease (COPD) who had been dispensed an ICS/LABA during 2009. Oral corticosteroid (OCS) and short-acting β₂ -agonist (SABA) use, and healthcare visits, were assessed pre- and post-index.
  
  
  RESULTS
  The ICS/LABA reimbursement policy change led to 47.8% fewer fixed ICS/LABA combinations being dispensed during the post-index period among patients whose asthma and/or COPD was controlled/partly controlled during the pre-index period. Fewer ICS monocomponents were also dispensed. A total of 48.6% of patients were no longer receiving any respiratory medications after the policy change. This was associated with reduced disease control, as demonstrated by more healthcare visits (44.0%), and more OCS (76.3%) and SABA (51.2%) dispensations.
  
  
  CONCLUSIONS
  Overall, these findings demonstrate that changes in healthcare policy and medication reimbursement can directly impact medication use and, consequently, clinical outcomes and should, therefore, be made cautiously.
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: U S
authors.initials: US
authors.lastname: Björnsdóttir
authors.forename: S T
authors.initials: ST
authors.lastname: Sigurðardóttir
authors.forename: J S
authors.initials: JS
authors.lastname: Jonsson
authors.forename: M
authors.initials: M
authors.lastname: Jonsson
authors.forename: G
authors.initials: G
authors.lastname: Telg
authors.forename: M
authors.initials: M
authors.lastname: Thuresson
authors.forename: I
authors.initials: I
authors.lastname: Naya
authors.forename: S
authors.initials: S
authors.lastname: Gizurarson
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000191:economics* / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000191:economics* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination / Q000191:economics*; D005260:Female; D006801:Humans; D007055:Iceland; D007349:Insurance, Health, Reimbursement / Q000639:trends*; D008173:Lung Diseases, Obstructive / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists