title: The effects of coxib formulary restrictions on analgesic use and cost: regional evidence from Canada.
abstract: BACKGROUND
  Public insurance plans for pharmaceuticals in Canada differ substantially across provinces in the conditions under which pharmaceuticals are reimbursed. Coxibs provide a good example. Québec had no restrictions on reimbursement for these drugs. Ontario required physicians to submit the clinical indications for their use on the prescription. British Columbia required physicians to seek and receive prior authorisation from the drug plan.
  
  
  OBJECTIVE
  This study compares the effects of different reimbursement policies on coxib, non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs), and gastro-protective agent (GPA) use and cost.
  
  
  METHODS
  Analysis of retrospective time series analysis of all NSAID and GPA administrative claims data from April 1997 through December 2002.
  
  
  METHODS
  Administrative claims data from April 1997 through December 2002 for each of the publicly funded drug plans in Québec, Ontario, and British Columbia. In addition, we obtained data from BC PharmaNet, which records all dispensed prescriptions in British Columbia.
  
  
  METHODS
  Senior beneficiaries (>or= 65 years).
  
  
  METHODS
  We compared the projected total NSAID utilisation in the absence of coxib reimbursement restriction with actual utilisation by province and drug category. Projected utilisation was based on ARIMA modelling and reported as the number of defined daily doses (DDDs) per 100 senior (>or=65 years) beneficiaries/month.
  
  
  RESULTS
  In Ontario, under its "limited use" policy, uptake and steady-state use of coxibs was similar to that in Québec, where there were no restrictions. In British Columbia, publicly funded use of coxibs was 6% of that in Ontario and Québec. Despite a shift to private reimbursement, total coxib use in BC was only 50% of use in Ontario and Québec. The use of all NSAIDS (nsNSAIDS plus coxibs) increased for all provincial drug plans except for BC. The increase and overall rate of total NSAID use was greatest in Ontario. Neither Ontario's nor BC's policies had an impact on use of nsNSAIDs or GPAs.
  
  
  CONCLUSIONS
  Only BC's policy effectively limited publicly funded coxib use. However, there was substantial cost-shifting to out-of-pocket and third party insurance plans in BC.
authors.affiliation: Centre for Evaluation of Medicines, 105 Main Street East, Level P1, Hamilton, ON L8N 1G6, Canada. marshd@mcmaster.ca
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Willison
authors.forename: Paul
authors.initials: P
authors.lastname: Grootendorst
authors.forename: Jacques
authors.initials: J
authors.lastname: LeLorier
authors.forename: Malcolm
authors.initials: M
authors.lastname: Maclure
authors.forename: Nathalie A
authors.initials: NA
authors.lastname: Kulin
authors.forename: Odile E
authors.initials: OE
authors.lastname: Sheehy
authors.forename: Leanne
authors.initials: L
authors.lastname: Warren
authors.forename: Kathy
authors.initials: K
authors.lastname: Sykora
authors.forename: Elham
authors.initials: E
authors.lastname: Rahme
mesh_terms: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002170:Canada; D052246:Cyclooxygenase 2 Inhibitors / Q000191:economics / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005569:Formularies as Topic; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*; D016134:Organizational Policy; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors