Abstract
The Australian Asthma Handbook does not recommend use of fixed dose combination (FDC) controller medicines for asthma in children aged ≤5 years. FDCs are only recommended in children and adolescents (aged 6–18 years) not responding to initial inhaled corticosteroid (ICS) therapy. Using Pharmaceutical Benefits Scheme dispensing claims from 2013–2018, we examined the annual incident FDC dispensing and the incident FDC dispensing without prior ICS up to 365 days. We also determined cost of FDCs to government and patients. During 2013–2018, there were 35,635 FDC initiations and 31,368 (88%) did not have a preceding ICS dispensing. The annual incidence of FDC dispensing declined from 14.7 to 7.2/1000 children. Incidence of FDC dispensing/1000 children without a preceding ICS declined from 2.1 to 0.5 in children aged 1–2 years, 7.2 to 1.7 in 3–5 years, 14.8 to 5.1 in 6–11 years, and 18.6 to 11.9 in ≥12years. The cost of FDCs was 7.8 million Australian dollars (AUD); of which 4.4 million AUD was to government and 3.3 million AUD was to patient. Despite inappropriate dispensing of FDCs in children aged ≤5 years, incidence of FDC dispensing and more importantly incidence without a preceding ICS is declining in Australia.
Highlights
Asthma is the most common chronic childhood disease
Despite inappropriate dispensing of fixed dose combination (FDC) in children aged ≤5 years, incidence of FDC dispensing and more importantly incidence without a preceding inhaled corticosteroid (ICS) is declining in Australia
It is estimated that 20.8% of Australian children aged 0–15 years have ever been diagnosed with asthma, while 11.3% of children have a current diagnosis [4]
Summary
In Australia, the prevalence of childhood asthma is higher than many other high-income countries [1,2,3]. The annual national hospitalisation rate for this disease is 495/100,000 children aged 0–14 years [5], costing the Australian health care system ~$200 million [6]. This high burden of asthma is in part due to variation in the clinical management of asthma resulting in low value care [7]. The appropriate management of asthma includes correct diagnosis, asthma self-management education, removal of modifiable triggers, and appropriate medication
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