A new study in the Canadian Medical Association Journal (CMAJ) reports that the number of prescriptions in Canada for cardiovascular medications has been increasing over the last ten years. There has been a 200 percent increase in costs. Overall costs of cardiovascular medications exceeded $5 billion in 2006. And statins accounted for nearly 40 percent of the expenditure.
Exercising a considerable public burden, cardiovascular disease is the leading cause of premature death and disability in Canada. Cardiovascular drugs are the most frequently prescribed medications in the country, and expenditures outpace overall drug prescription increases.
Costs are predicted to rise to around $10.6 billion in 2020 if this tendency continues. This could threaten the sustainability of public drug insurance programs. In 2007, Canadians spent 17 cents of every healthcare dollar on medication. This represents a 16 percent increase in comparative healthcare spending since 1997.
There are factors that can only partially explain the significant increase in costs, such as population growth, increasing rates of hypertension, pharmaceutical cost inflation and an ageing population. Across the provinces, there are differences, such as higher costs in the east. Increases in prescription volume and use of new and more expensive cardiovascular medications are also encouraging this rise. But this approach requires further examination since some recognized older drugs could be the best cost-effective option.
Dr. Cynthia Jackevicius, a researcher at the Institute for Clinical Evaluative Sciences (ICES) in Toronto and Western University of Health Sciences in Ponoma, USA and coauthors from the Canadian Cardiovascular Outcomes Research Tea (CCORT) explain: “We found that the medication classes with the greatest increases in prescriptions dispensed and associated expenditures were angiotensin receptor blockers, antiplatelets, statins and angiotensin converting enzyme inhibitors.” Several of these medications are brand name drugs. The authors advise that older drugs may still be the best choice.
Researchers participating in the CCORT initiative conducted the study. It included experts from the Institute for Clinical Evaluative Sciences, University Health Network, University of Toronto, Toronto, Ontario, and Western University of Health Sciences in Ponoma, USA; Dalhousie University; Laval University; University of Ottawa Heart Institute; Statistics Canada; McGill University and University of British Columbia.
The authors write in conclusion: “Given the magnitude of growth of the expenditures involved, ensuring the prescribing of cost-effective medications is essential.”
In an associated note, Dr. Robert Califf from Duke University Medical Center explains that the higher costs of cardiovascular medication prescribing could have the effect of a health benefit that would be worth the increases in spending. He comments that precise data such as prescribing information should be included in electronic medical records. This could provide rapid evidence about the optimum medications for patient conditions and could be integrated into practice.
“Long-term trends in use of and expenditures for cardiovascular medications in Canada”
Cynthia A. Jackevicius, PharmD MSc, Jafna L. Cox, BA MD, Daniel Carreon, BSc, Jack V. Tu, MD PhD, Stéphane Rinfret, MD MSc, Derek So, MD, Helen Johansen, PhD, Dimitri Kalavrouziotis, MD MSc, Virginie Demers, MD, Karin Humphries, MBA DSc, Louise Pilote, MD PhD for the Canadian Cardiovascular Outcomes Research Team
doi:10.1503/cmaj.081913
“Rational use of medications: If Canada can’t do it …”
Robert M. Califf, MD
doi:10.1503/cmaj.090861
cmaj.ca
Written by Stephanie Brunner (B.A.)