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J Asthma Allergy. 2017 May 9;10:153-161. doi: 10.2147/JAA.S128431. eCollection 2017.

Medication-related costs of rhinitis in Australia: a NostraData cross-sectional study of pharmacy purchases.

Author information

Clinical Medicine, Griffith University, Southport, QLD, Australia.
Observational and Pragmatic Research Institute, Singapore.
Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
Applied Medical Research Center, University of New South Wales, Sydney, NSW, Australia.
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, SA, Australia.
Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
Central Sydney Area Health Service, Sydney, NSW, Australia.
NostraData, Kew, VIC, Australia.
Optimum Patient Care, Cambridge, UK.



There is a relative paucity of research regarding medication expenditure associated with multiple-therapy use for rhinitis in Australia. To describe 1) the nature and extent of multiple-therapy use for rhinitis in Australia using data on therapies purchased with prescription or over-the-counter (OTC) and 2) additional costs incurred by multiple-therapy use compared with intranasal corticosteroid (INCS) therapy alone.


A retrospective observational study was carried out using a database containing anonymous pharmacy transaction data available from 20% of pharmacies in Australia that links doctor prescriptions and OTC purchase information. Pharmacy purchases of at least one prescription or OTC rhinitis treatment, with or without additional asthma/chronic obstructive pulmonary disease (COPD) therapy, by patients during 2013 and 2014 were assessed.


In total, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over 24 months. The majority of rhinitis therapy transactions were single-therapy purchases without additional asthma/COPD therapy. Of the single therapies purchased, 73% were oral antihistamines (OAHs) and 15% were INCS therapy. Dual-therapy purchases of INCSs and OAHs accounted for 40% of multiple-therapy purchases. Patients frequently purchased OAHs, nonsteroidal nasal sprays, and eye drops for allergic conjunctivitis alongside INCSs, resulting in higher financial costs (up to AU$21 per treatment episode) compared with INCS monotherapy.


This study highlighted the significant burden posed on community pharmacy to address the needs of people with rhinitis symptoms, and the failure to translate the evidence that INCSs are the most effective monotherapy for moderate to severe and/or persistent rhinitis into clinical practice in light of the lack of evidence supporting combination of INCS and OAH therapy. Health care professional engagement, especially at the pharmacy level, will be extremely important if we wish to ensure that the purchase of rhinitis treatment is in accordance with guidelines and that their use is optimal.


community pharmacy; intranasal corticosteroids; oral antihistamines; over-the-counter; prescription; rhinitis; therapy

Conflict of interest statement

Disclosure Pete Smith has received honoraria from AstraZeneca, Glaxo-SmithKline, Meda Pharmaceuticals, and Mundipharma. David Price has board membership with Aerocrine, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals; consultancy with Almirall, Amgen, AstraZeneca, Boeh-ringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Mundipharma, Napp, Novartis, Pfizer, Teva Pharmaceuticals, and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from UK National Health Service, British Lung Foundation, Aerocrine, AKL Research and Development Ltd, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, Pfizer, Respiratory Effectiveness Group, Takeda, Teva Pharmaceuticals, Zentiva, and Theravance; payment for lectures/speaking engagements from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Meda, Merck, Mundipharma, Novartis, Pfizer, Skyepharma, Takeda, and Teva Pharmaceuticals; payment for manuscript preparation from Mundipharma and Teva Pharmaceuticals; payment for the development of educational materials from Novartis and Mundipharma; payment for travel/accommodation/meeting expenses from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis, Teva Pharmaceuticals, and AstraZeneca; funding for patient enrollment or completion of research from Chiesi, Teva Pharmaceuticals, Zentiva, and Novartis; stock/stock options from AKL Research and Development Ltd, which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd, UK, and 74% of Observational and Pragmatic Research Institute Pte Ltd, Singapore; and is peer reviewer for grant committees of the Medical Research Council, Efficacy and Mechanism Evaluation Programme, and Health Technology Assessment. Richard Harvey is a consultant for Medtronic, Neilmed, and Olympus, and has received honoraria from Sequiris and grant support from Meda Pharmaceuticals, Neilmed, and Stallergenes. Andrew Simon Carney is a consultant for Olympus and Smith & Nephew, and has received honoraria from Meda Pharmaceuticals. Vicky Kritikos has received honoraria from AstraZeneca, GlaxoSmithKline, and Pfizer. Sinthia Z Bosnic-Anticevich has received honoraria from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Mundipharma, and Teva Pharmaceuticals for her contribution to advisory boards/key international expert forum. Alice Marie Sybille Durieux has conducted paid research in respiratory disease in the past 5 years on behalf of Aerocrine, AKL Research and Development Ltd, Almirall, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda Pharmaceuticals, Mundipharma, Napp, Novartis, Orion, Takeda, Teva Pharmaceuticals, and Zentiva. The authors report no other conflicts of interest in this work.

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