Measured and perceived affordability of asthma medications and their associations with medication adherence among adult patients in Ethiopia: A cross-sectional study.

INTRODUCTION: Effective asthma management depends on regular use of essential medications, yet high costs and low affordability often hinder adherence. This study assessed measured and perceived affordability of asthma medications, examined their associations with medication adherence, and identified factors associated with perceived affordability among patients in the Amhara Region, Ethiopia. METHODS: An institution-based cross-sectional study was conducted from May to August 2024, including 312 eligible asthma patients attending four high-volume hospitals in the region. A total of 296 patients were consecutively sampled during the study period, utilizing structured interviewer administered questionnaires to collect data on socio-demographic, clinical, economic, and perceptions of medication affordability. Validity and reliability of the instruments were established through expert review, factor analysis, and Cronbach's alpha, ensuring accurate measurement of perceived affordability and adherence, with affordability assessed via income-based thresholds and medication adherence measured by the MARS scale. Analysis in SPSS involved descriptive statistics, Spearman's correlation, and multivariable logistic regression to explore relationships and predictors related to affordability and adherence. RESULTS: Measured affordability was not significantly correlated with perceived affordability (ρ = -0.013, p = 0.826) or adherence (ρ = -0.024, p = 0.678). In contrast, perceived affordability showed a moderate positive correlation with adherence (ρ = 0.333, p < 0.001). Factors significantly associated with higher perceived affordability included health insurance coverage (AOR =2.693, 95% CI:1.202-6.036, p = 0.016), being prescribed fewer than two medications (AOR =3.444, 95% CI: 1.777-6.687, p < 0.001), medication availability in hospital pharmacy dispensaries (AOR = 5.549, 95% CI: 2.777-11.09, p < 0.001), absence of hospitalization (AOR =2.299, 95% CI: 1.15-4.13, p = 0.018), and irregular follow-up (AOR =3.413, 95% CI: 1.416-8.23, p = 0.006). Conversely, government employment (AOR =0.244, 95% CI: 0.08-0.0.748, p = 0.014) and higher travel costs (AOR = 0.986, 95% CI: 0.976-0.997, p = 0.01) reduced perceived affordability. CONCLUSION: Perceived affordability, rather than measured affordability, significantly influences medication adherence among patients with asthma. Enhancing perceived affordability through expanded health insurance, consistent drug availability, reduced indirect costs, and promoting regular follow-up may improve treatment adherence and asthma outcomes by considering telemedicine, mobile health, or community-based follow-ups to cut transportation costs and save patients time.