Lu Lingyun, Krumholz Harlan M, Tu Jack V, Ross Joseph S, Ko Dennis T, Jackevicius Cynthia A
From the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (L.L., C.A.J.); Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA (L.L., C.A.J.); Department of Medicine, Section of Cardiovascular Medicine (H.M.K.) and Center for Outcomes Research and Evaluation, Yale New Haven Hospital (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (H.M.K., J.S.R.); Robert Wood Johnson Clinical Scholars Program, New Haven, CT (H.M.K., J.S.R.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (J.V.T., D.T.K., C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine (J.V.T., D.T.K., C.A.J.) and Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.); and University Health Network, Toronto, Ontario, Canada (C.A.J.).
Circ Cardiovasc Qual Outcomes. 2014 Jul;7(4):589-96. doi: 10.1161/CIRCOUTCOMES.114.001023. Epub 2014 Jun 3.
Ezetimibe use has steadily increased in Canada during the past decade even in the absence of evidence demonstrating a beneficial effect on clinical outcomes. Among the 4 most populated provinces in Canada, there is a gradient in the restrictiveness of ezetimibe in public-funded formularies (most to least strict: British Columbia, Alberta, Quebec, and Ontario). The effect of formulary policy on the use of ezetimibe over time is unknown.
We conducted a population-level cohort study using Intercontinental Marketing Services Health Canada's data from June 2003 to December 2012 to examine ezetimibe use in these 4 provinces to better understand the association between use and formulary restrictiveness. We found regional variations in the patterns of ezetimibe use. From June 2003 to December 2012, British Columbia (most restrictive) had the lowest monthly increasing rate from $261 to $21 926 ($190/100 000 population/mo), whereas Ontario (least restrictive) had the most rapid monthly increase from $223 to $74 030 ($ 647/100 000 population/mo), and Quebec from $130 to $59 690 ($522/100 000 population/mo) and Alberta from $356 to $ 37 604 ($327/100 000 population/mo) were intermediate (P<0.001).
Ezetimibe use remains common, increasing during the past decade. Use steadily increased in provinces with the most lenient formularies. In contrast, use was lower, plateauing since 2008 in British Columbia and Alberta, which have more restrictive formularies. The gradient in ezetimibe use was related to variability in restrictiveness of the provincial formularies, illustrating the potential of a policy response gradient that may be used to more effectively manage medication use.
在过去十年中，依折麦布在加拿大的使用量稳步上升，即便缺乏证据表明其对临床结局有有益影响。在加拿大人口最多的4个省份中，公共资助药品目录中依折麦布的限制程度存在梯度差异（从最严格到最宽松依次为：不列颠哥伦比亚省、艾伯塔省、魁北克省和安大略省）。药品目录政策对依折麦布随时间推移使用情况的影响尚不清楚。
我们利用加拿大健康部洲际营销服务公司2003年6月至2012年12月的数据进行了一项基于人群的队列研究，以调查这4个省份中依折麦布的使用情况，从而更好地了解其使用与药品目录限制程度之间的关联。我们发现依折麦布的使用模式存在地区差异。从2003年6月至2012年12月，不列颠哥伦比亚省（限制最严格）的月增长率最低，从261美元增至21926美元（每10万人口每月190美元），而安大略省（限制最宽松）的月增长率最快，从223美元增至74030美元（每10万人口每月647美元），魁北克省从130美元增至59690美元（每10万人口每月522美元），艾伯塔省从356美元增至37604美元（每10万人口每月327美元），处于中间水平（P<0.001）。
依折麦布的使用仍然普遍，在过去十年中呈上升趋势。在药品目录最宽松的省份，其使用量稳步增加。相比之下，在药品目录限制更严格的不列颠哥伦比亚省和艾伯塔省，其使用量较低，自2008年以来趋于平稳。依折麦布使用情况的梯度与省级药品目录限制程度的差异有关，这表明了一种政策应对梯度的潜力，可用于更有效地管理药物使用。
