Marshall Deborah A, Willison Donald J, Grootendorst Paul, LeLorier Jacques, Maclure Malcolm, Kulin Nathalie A, Sheehy Odile E, Warren Leanne, Sykora Kathy, Rahme Elham
Centre for Evaluation of Medicines, 105 Main Street East, Level P1, Hamilton, ON L8N 1G6, Canada.
Health Policy. 2007 Nov;84(1):1-13. doi: 10.1016/j.healthpol.2007.04.010. Epub 2007 Jun 13.
Public insurance plans for pharmaceuticals in Canada differ substantially across provinces in the conditions under which pharmaceuticals are reimbursed. Coxibs provide a good example. Québec had no restrictions on reimbursement for these drugs. Ontario required physicians to submit the clinical indications for their use on the prescription. British Columbia required physicians to seek and receive prior authorisation from the drug plan.
This study compares the effects of different reimbursement policies on coxib, non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs), and gastro-protective agent (GPA) use and cost.
Analysis of retrospective time series analysis of all NSAID and GPA administrative claims data from April 1997 through December 2002.
Administrative claims data from April 1997 through December 2002 for each of the publicly funded drug plans in Québec, Ontario, and British Columbia. In addition, we obtained data from BC PharmaNet, which records all dispensed prescriptions in British Columbia.
Senior beneficiaries (>or= 65 years).
We compared the projected total NSAID utilisation in the absence of coxib reimbursement restriction with actual utilisation by province and drug category. Projected utilisation was based on ARIMA modelling and reported as the number of defined daily doses (DDDs) per 100 senior (>or=65 years) beneficiaries/month.
In Ontario, under its "limited use" policy, uptake and steady-state use of coxibs was similar to that in Québec, where there were no restrictions. In British Columbia, publicly funded use of coxibs was 6% of that in Ontario and Québec. Despite a shift to private reimbursement, total coxib use in BC was only 50% of use in Ontario and Québec. The use of all NSAIDS (nsNSAIDS plus coxibs) increased for all provincial drug plans except for BC. The increase and overall rate of total NSAID use was greatest in Ontario. Neither Ontario's nor BC's policies had an impact on use of nsNSAIDs or GPAs.
Only BC's policy effectively limited publicly funded coxib use. However, there was substantial cost-shifting to out-of-pocket and third party insurance plans in BC.
加拿大各省的公共药品保险计划在药品报销条件方面存在很大差异。昔布类药物就是一个很好的例子。魁北克对这些药物的报销没有限制。安大略要求医生在处方上提交其使用的临床指征。不列颠哥伦比亚要求医生向药品计划寻求并获得事先授权。
本研究比较不同报销政策对昔布类药物、非选择性非甾体抗炎药（nsNSAIDs）和胃保护剂（GPA）使用及费用的影响。
对1997年4月至2002年12月期间所有非甾体抗炎药和胃保护剂行政索赔数据进行回顾性时间序列分析。
魁北克、安大略和不列颠哥伦比亚各公共资助药品计划1997年4月至2002年12月的行政索赔数据。此外，我们从BC PharmaNet获得了数据，该数据库记录了不列颠哥伦比亚所有配发的处方。
老年受益人（≥65岁）。
我们将在没有昔布类药物报销限制的情况下预计的非甾体抗炎药总使用量与各省和药品类别的实际使用量进行了比较。预计使用量基于自回归积分滑动平均（ARIMA）模型，并报告为每100名老年（≥65岁）受益人/月的限定日剂量（DDD）数。
在安大略，在其“有限使用”政策下，昔布类药物的使用量和稳态使用量与没有限制的魁北克相似。在不列颠哥伦比亚，公共资助的昔布类药物使用量是安大略和魁北克的6%。尽管转向了私人报销，但不列颠哥伦比亚的昔布类药物总使用量仅为安大略和魁北克的50%。除不列颠哥伦比亚外，所有省级药品计划中所有非甾体抗炎药（nsNSAIDs加昔布类药物）的使用量均有所增加。安大略非甾体抗炎药总使用量的增加幅度和总体使用率最大。安大略和不列颠哥伦比亚的政策对nsNSAIDs或GPA的使用均无影响。
只有不列颠哥伦比亚的政策有效限制了公共资助的昔布类药物使用。然而，在不列颠哥伦比亚，费用大量转移到了自付费用和第三方保险计划。
