Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont.
CMAJ Open. 2020 Apr 28;8(2):E297-E303. doi: 10.9778/cmajo.20190231. Print 2020 Apr-Jun.
Drugs are the fastest growing cost in the Canadian health care system, owing to the increasing number of high-cost drugs. The objective of this study was to examine the characteristics of high-drug-cost beneficiaries of public drug plans across Canada relative to other beneficiaries.
We conducted a cross-sectional study among public drug plan beneficiaries residing in all provinces except Quebec. We used the Canadian Institute for Health Information's National Prescription Drug Utilization Information System to identify all drugs dispensed to beneficiaries of public drug programs in 2016/17. We stratified the cohort into 2 groups: high-drug-cost beneficiaries (top 5% of beneficiaries based on annual costs) and other beneficiaries (remaining 95%). For each group, we reported total drug costs, prevalence of high-cost claims (> $1000), median number of drugs, proportion of beneficiaries aged 65 or more, the 10 most costly reimbursed medications and the 10 medications most commonly reimbursed. We reported estimates overall and by province.
High-drug-cost beneficiaries accounted for nearly half (46.5%) of annual spending, with an average annual spend of $14 610 per beneficiary, compared to $1570 among other beneficiaries. The median number of drugs dispensed was higher among high-drug-cost beneficiaries than among other beneficiaries (13 [interquartile range (IQR) 7-19] v. 8 [IQR 4-13]), and a much larger proportion of high-drug-cost beneficiaries than other beneficiaries received at least 1 high-cost claim (40.9% v. 0.6%). Long-term medications were the most commonly used medications for both groups, whereas biologics and antivirals were the most costly medications for high-drug-cost beneficiaries.
High-drug-cost beneficiaries were characterized by the use of expensive medications and polypharmacy relative to other beneficiaries. Interventions and policies to help reduce spending need to consider both of these factors.
由于高成本药物的数量不断增加，药品是加拿大医疗保健系统中增长最快的成本。本研究的目的是研究加拿大各省份公共药物计划中高药费受益人与其他受益人的特征。
我们对居住在魁北克省以外所有省份的公共药物计划受益人群进行了横断面研究。我们使用加拿大卫生信息研究所的国家处方药物利用信息系统，确定了 2016/17 年公共药物计划受益人群中所有发放的药物。我们将队列分为两组：高药费受益人群（按年费用划分，前 5%的受益人群）和其他受益人群（其余 95%的受益人群）。对于每个组，我们报告了总药物费用、高费用索赔（> 1000 美元）的患病率、中位数药物数量、65 岁或以上受益人的比例、报销费用最高的 10 种药物和报销最常用的 10 种药物。我们按总体和省份报告了估计值。
高药费受益人群占年支出的近一半（46.5%），每位受益人的年平均支出为 14610 美元，而其他受益人群为 1570 美元。高药费受益人群的药物分发中位数高于其他受益人群（13 [四分位距 7-19] v. 8 [四分位距 4-13]），高药费受益人群中至少有 1 次高费用索赔的比例明显高于其他受益人群（40.9% v. 0.6%）。长期药物是两组最常用的药物，而生物制剂和抗病毒药物是高药费受益人群中最昂贵的药物。
高药费受益人群的特点是使用昂贵的药物和多种药物治疗，相对于其他受益人群。帮助降低支出的干预措施和政策需要考虑这两个因素。
