Abstract
Background
This study aimed to assess the impact of the type of drug plan on adherence to antihypertensive
medication treatment as well as the cost of these medications within universal drug
insurance programs.
Methods
To compare adherence to antihypertensive medication treatment and the cost of antihypertensive
medications between adults with public and private drug insurance in the province
of Québec, Canada, we reconstructed a matched retrospective cohort by linking data
recorded in 3 administrative databases between March 2008 and May 2010. The cohort
included 186 privately and 1747 publicly insured patients aged 18-64 years who were
treated with 1 or 2 antihypertensive medications. Adherence measured with the proportion
of days covered (PDC) over 1 year and the cost of antihypertensive medications were
evaluated for new and prevalent users separately.
Results
More than 70% of patients were 50-64 years old and 90% of the publicly and 72% of
the privately insured patients were using only 1 antihypertensive medication. The
mean PDC among new users of 1 antihypertensive medication was 58.8% for privately
insured patients and 65.0% for publicly insured patients, but the difference was not
statistically significant. However, privately insured patients treated with 2 antihypertensive
medications were more likely to be adherent (PDC-P, 15.0%; 95% confidence interval,
7.0-24.0). Privately insured patients (CAD$41.52) had to pay significantly more for
their antihypertensive medications than did publicly insured patients (CAD$32.21).
Conclusions
The cost of antihypertensive medications was higher for patients with private drug
insurance, although adherence was similar in both groups. The results may reflect
regulation of dispensing fees for publicly insured patients.
Résumé
Introduction
Cette étude a pour but d’évaluer l'impact du type de régime d’assurance médicaments
sur l’observance du traitement médicamenteux contre l’hypertension ainsi que sur le
coût de ces médicaments dans le cadre des programmes universels d’assurance médicaments.
Méthodes
Pour comparer l’observance du traitement médicamenteux contre l’hypertension et le
coût des médicaments antihypertenseurs entre les adultes couverts par un régime public
d’assurance médicaments et ceux couverts par un régime privé d’assurance médicaments
de la province de Québec, au Canada, nous avons reconstitué une cohorte rétrospective
appariée en reliant les données enregistrées de 3 bases de données administratives
entre mars 2008 et mai 2010. La cohorte incluait 186 patients de 18 à 64 ans couverts
par un régime public d’assurance et 1747 patients couverts par un régime privé d’assurance
qui étaient traités par 1 ou 2 médicaments antihypertenseurs. L’observance mesurée
par la proportion de jours couverts (PDC) durant 1 année, et le coût des médicaments
antihypertenseurs ont été évalué séparément chez les nouveaux utilisateurs et les
utilisateurs prévalents.
Résultats
Plus de 70 % des patients étaient âgés de 50 à 64 ans, et 90 % des patients couverts
par un régime public d’assurance et 72 %, par un régime privé d’assurance utilisaient
seulement 1 médicament hypertenseur. La PDC moyenne parmi les nouveaux utilisateurs
de 1 médicament hypertenseur était de 58,8 % chez les patients couverts par un régime
privé d’assurance et de 65,0 % chez les patients couverts par un régime public d’assurance,
mais la différence n’était pas statistiquement significative. Cependant, les patients
couverts par un régime privé d’assurance qui étaient traités par 2 médicaments antihypertenseurs
étaient plus susceptibles de respecter l'observance (PDC-P, 15,0 %; intervalle de
confiance à 95 %, 7,0-24,0). Les patients couverts par un régime d’assurance privé
(41,52 $ CA) devaient payer leurs médicaments antihypertenseurs beaucoup plus chers
que les patients couverts par un régime public d’assurance (32,21 $ CA).
Conclusions
Le coût des médicaments antihypertenseurs était plus élevé chez les patients couverts
par un régime privé d’assurance médicaments, quoique l’observance ait été similaire
dans les deux groupes. Les résultats peuvent être le reflet de la réglementation des
honoraires du pharmacien chez les patients couverts par un régime public d’assurance.
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Article info
Publication history
Published online: December 11, 2013
Accepted:
November 21,
2013
Received:
September 24,
2013
Footnotes
See page 566 for disclosure information.
Identification
Copyright
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
