{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T23:15:07Z","timestamp":1767827707729,"version":"3.49.0"},"reference-count":36,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2019,6,25]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Switching inhalers to cheaper equivalent products is often advocated as a necessary cost saving measure, yet the impact on patient\u2019s health and healthcare utilisation has not been measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified asthma and chronic obstructive pulmonary disease (COPD) patients from UK primary care electronic healthcare records between 2000 and 2016. A self-controlled case series was used to estimate incidence rate ratios (IRR); comparing outcome rates during the risk period, 3\u2009months after the exposure (financially motivated switch), and control periods (preswitch and postrisk period). Four outcomes were assessed: disease exacerbation, general practitioner consultation, non-specific respiratory events and adverse-medication events. Medication possession ratio (MPR) was calculated to assess adherence. 2017 National Health Service indicative prices were used to estimate cost differences per equivalent dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified a cohort of 569\u2009901 asthma and 171 231 COPD regular inhaler users, 2% and 6% had been switched, respectively. Inhaler switches between a brand-to-generic inhaler, and all other switches (brand-to-brand, generic-to-generic, generic-to-brand), were associated with reduced exacerbations (brand-to-generic: IRR=0.75, 95%\u2009CI 0.64 to 0.88; all other: IRR=0.79, 95%\u2009CI 0.71 to 0.88). Gender, age, therapeutic class, inhaler device and inhaler-technique checks did not significantly modify this association (p&lt;0.05). The rate of consultations, respiratory-events and adverse-medication events did not change significantly (consultations: IRR=1.00, 95%\u2009CI 0.99 to 1.01; respiratory-events: IRR=0.96, 95%\u2009CI 0.95 to 0.97; adverse-medication-events: IRR=1.05, 95%\u2009CI 0.96 to 1.15). Adherence significantly increased post-switch (median MPR: pre-switch=54%, post-switch=62%; p&lt;0.001). Switching patients, in the cohort of regular inhaler users, to the cheapest equivalent inhaler, could have saved around \u00a36\u2009million annually.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Switching to an equivalent inhaler in patients with asthma or COPD appeared safe and did not negatively affect patient\u2019s health or healthcare utilisation.<\/jats:p><\/jats:sec>","DOI":"10.1136\/thoraxjnl-2018-212957","type":"journal-article","created":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T21:15:41Z","timestamp":1565039741000},"page":"1078-1086","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Cost saving of switching to equivalent inhalers and its effect on health outcomes"],"prefix":"10.1136","volume":"74","author":[{"given":"Chloe I","family":"Bloom","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Douglas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Olney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grainne","family":"D'Ancona","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liam","family":"Smeeth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-4869","authenticated-orcid":false,"given":"Jennifer K","family":"Quint","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,5]]},"reference":[{"issue":"Suppl 3","key":"2024092103201585000_74.11.1078.1","doi-asserted-by":"crossref","first-page":"A20.1","DOI":"10.1136\/thoraxjnl-2016-209333.38","article-title":"S32\u2005Epidemiology of chronic obstructive pulmonary disease (COPD) in the uk: findings from the british lung foundation\u2019s \u2018respiratory health of the nation\u2019 project","volume":"71","author":"Snell","year":"2016","journal-title":"Thorax"},{"key":"2024092103201585000_74.11.1078.2","unstructured":"National Institute for Health and Care Excellence . 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