Hasan Haroon, Howard Fuchsia, Morgan Steven G, Metzger Daniel L, Lo Andrea C, Goddard Karen, Gill Sabrina, Johnson Michelle
Project Manager, Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC.
Post-Doctoral Fellow, School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC.
Healthc Policy. 2014 Feb;9(3):80-96.
Young adult survivors of paediatric brain tumours (PBTs) who have been treated with radiation therapy will likely be severely growth hormone-deficient when retested at the achievement of final height. Growth hormone replacement therapy (GHRT) is administered to treat growth hormone deficiency (GHD). Public drug coverage for GHRT falls under the responsibility of provincial governments across Canada. This study sought to determine the extent of public drug coverage and cost in each Canadian province for GHRT to treat GHD during adulthood for young adult survivors of PBTs.
Data were collected from provincial government resources and drug formularies from 2012-2013 on the extent of coverage for GHRT based on a clinical case scenario representative of a young adult survivor of a PBT with childhood-onset radiation-induced GHD, the ingredient cost for GHRT and the applicable provincial public drug plan cost-sharing policies. A model was then created to simulate out-of-pocket costs incurred by a young adult male and a young adult female survivor of a PBT for one year of GHRT in each province with applicable cost-sharing arrangements and levels of low annual individual total income that best represent the majority of young adult survivors of PBTs. Out-of-pocket costs were expressed as a percentage of annual income. Comparisons were made between provinces descriptively, and variation among provinces was summarized statistically.
Alberta, Manitoba, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador provide coverage for GHD during adulthood on a case-by-case basis, while British Columbia, Saskatchewan, Nova Scotia and Prince Edward Island provide no coverage. The percentage of annual income to fund GHRT across the provinces without public coverage ranged from 14.4% to 25.5% for males and 21.5% to 38.3% for females, and with public coverage was 0.0% to 4.1% for males and 0.0% to 5.0% for females.
There are considerable out-of-pocket costs and variation in coverage provided by provincial public drug plans to fund GHRT for young adult survivors of PBTs with GHD. The implementation of a national drug formulary could potentially prevent undue financial hardship and remove disparities resulting from variations in provincial drug plans.
接受过放射治疗的小儿脑肿瘤（PBT）成年幸存者在达到最终身高时再次检测，很可能会严重缺乏生长激素。生长激素替代疗法（GHRT）用于治疗生长激素缺乏症（GHD）。加拿大各省的省政府负责公共药物覆盖范围内的GHRT。本研究旨在确定加拿大各省为PBT成年幸存者治疗成年期GHD的GHRT提供公共药物覆盖的范围和成本。
从省级政府资源和2012 - 2013年的药品处方集收集数据，内容包括基于一个代表患有儿童期辐射诱发GHD的PBT成年幸存者的临床病例情景的GHRT覆盖范围、GHRT的成分成本以及适用的省级公共药物计划费用分摊政策。然后创建一个模型，模拟一名PBT成年男性和一名成年女性幸存者在每个省份接受一年GHRT的自付费用，考虑适用的费用分摊安排以及最能代表大多数PBT成年幸存者的低年度个人总收入水平。自付费用以年收入的百分比表示。对各省进行描述性比较，并对各省之间的差异进行统计总结。
艾伯塔省、马尼托巴省、安大略省、魁北克省、新不伦瑞克省以及纽芬兰与拉布拉多省逐案为成年期GHD提供覆盖，而不列颠哥伦比亚省、萨斯喀彻温省、新斯科舍省和爱德华王子岛省则不提供覆盖。在没有公共覆盖的省份，男性为GHRT提供资金的年收入百分比在14.4%至25.5%之间，女性在21.5%至38.3%之间；有公共覆盖的省份，男性为0.0%至4.1%，女性为从0.0%至5.0%。
省级公共药物计划为患有GHD的PBT成年幸存者提供GHRT资金时，存在相当大的自付费用和覆盖差异。实施国家药品处方集可能会避免不必要的经济困难，并消除省级药物计划差异导致的不平等现象。
