The province of British Columbia was right to take a cautious approach to coverage of the inhaled medication Spiriva, suggests a study to be published today in the journal Value in Health, the official journal of ISPOR. Researchers at the University of British Columbia studied the impact of the province's coverage of the drug on costs and use of health services.

The study included patients taking either of two commonly used inhaled anticholinergic drugs, Spiriva and Atrovent, which are typically used in the treatment of chronic obstructive pulmonary disease (COPD). A provincial policy introduced in July 2007 provided reimbursement for Spiriva but restricted coverage to patients with specific lung function test results and with an inadequate response to Atrovent. The coverage policy reduced out-of-pocket drug costs paid by patients, but increased total health costs by an estimated CAD $10 million over two and a half years. More importantly, researchers found no evidence that increased use of Spiriva translated to fewer hospitalizations or physician office visits.

"This policy increased the use of Spiriva," said lead author Colin Dormuth. "But in our study we found no benefit to the rest of the health care system in terms of lower rates of hospitalization or visits to doctors. In fact, emergency hospitalizations appeared to increase slightly."

The study authors emphasized that more research on the health outcomes of the two medications is needed to draw strong conclusions about health impacts. Cost increases stemmed from an estimated $1.5 million increase in medication costs and added hospital costs estimated at $8.5 million. At $95 per prescription in 2009, Spiriva was more expensive than Atrovent at $32.

After the policy to cover Spiriva for some patients started, hospitalizations increased by 776 emergency admissions for COPD and by 1,272 hospital admissions for any reason as compared to the expected admissions over a period of two and a half years.

The study found that total use of Spiriva and Atrovent remained about the same, but medication use shifted toward greater use of Spiriva. Use of Spiriva increased by 24 percent in the two and a half years after the reimbursement policy was introduced.