Recent trends in pirfenidone and nintedanib use for idiopathic pulmonary fibrosis in Australia
Ingrid A. Cox
A B , Barbara de Graaff A B , Tamera J. Corte B C D , Ian Glaspole B E F , Daniel C. Chambers B G H , Yuben Moodley B I J K , Alan Teoh B D , E. Haydn Walters A B * and Andrew J. Palmer A B L M *
A Menzies Institute for Medical Research, The University of Tasmania, Hobart, Tas., Australia. Email: ingrid.cox@utas.edu.au; barbara.degraaff@utas.edu.au; haydn.walters@utas.edu.au
B National Health and Medical Research Council (NHMRC) Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia. Email: tamera.corte@sydney.edu.au; ian.glaspole@monash.edu; alan.teoh@health.nsw.gov.au
C Central Clinical School, The University of Sydney, Camperdown, NSW, Australia.
D Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
E Interstitial Lung Disease Clinic, Alfred Hospital, Melbourne, Vic., Australia.
F Central Clinical School, Monash University, Melbourne, Vic., Australia.
G School of Clinical Medicine, The University of Queensland, Brisbane, Qld, Australia. Email: daniel.chambers@health.qld.gov.au
H Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Qld, Australia.
I Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia. Email: yuben.moodley@uwa.edu.au
J Institute of Respiratory Health, The University of Western Australia, Perth, WA, Australia.
K Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia.
L Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.
M Corresponding author. Email: andrew.palmer@utas.edu.au
Australian Health Review 45(6) 718-727 https://doi.org/10.1071/AH20337
Submitted: 25 November 2020 Accepted: 10 March 2021 Published: 28 October 2021
Abstract
Objectives Idiopathic pulmonary fibrosis (IPF) is one of the most common forms of interstitial lung disease presenting in people aged ≥50 years. There is currently no cure for IPF, but two medications (pirfenidone and nintedanib) have been shown to slow the functional decline of the lungs. In 2017, these two medications were listed on the Pharmaceutical Benefits Scheme (PBS) for subsidisation in Australia. This study evaluated local trends in the use of these two medications.
Methods Prescription data for this analysis were obtained from the PBS Item Reports for the period May 2017–May 2020. Population data were extracted from the Australian Bureau of Statistics data cubes. A descriptive approach was used to conduct and report the analysis to illustrate trends in the use of these two medications and associated costs.
Results There were 44 010 prescriptions processed for the treatment for IPF in the 3-year period. Nintedanib use was higher than pirfenidone use, accounting for 54% of prescriptions. New South Wales accounted for 35% of the total prescriptions but, when standardised against population size, the Australian Capital Territory accounted for the highest proportion of prescriptions (24%). Prescriptions for nintedanib and pirfenidone were associated with a total cost of A$131 377 951 over the period 2017–20.
Conclusion This study provides initial information on prescription rates, practices and expenditure for pirfenidone and nintedanib. In addition, we provide some insight into possible pharmacological and epidemiological trends based on jurisdictional differences. Together, the results from this study provide a platform for future research given the dearth of information on IPF in Australia.
What is known about the topic? Data regarding trends in the utilisation of antifibrotics for the treatment of IPF in Australia are currently limited.
What does this paper add? This study demonstrated that nintedanib use was slightly higher than pirfenidone use, and that there were variations in jurisdictional prescribing practices. The highest number of prescriptions and costs were attributable to New South Wales but, when standardised against population size, the Australian Capital Territory had the highest number of prescriptions and costs.
What are the implications for practitioners? This study provides some insights into the use of pirfenidone and nintedanib, as well as pharmacoepidemiological trends, in Australia, which is useful for economic evaluation and modelling future health expenditure.
Keywords: antifibrotics, pharmacoepidemiology, health economics, health funding and financing, interstitial lung disease, idiopathic pulmonary fibrosis, medication costs, pharmaceuticals.
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