title: Usage and equity of access to isotretinoin in New Zealand by deprivation and ethnicity.
abstract: OBJECTIVE
  Oral isotretinoin, for severe acne, was until March 2009 fully funded in New Zealand only if the prescription was written by a vocationally registered dermatologist. This funding restriction was argued on the basis of complexity of management and an appreciable risk of teratogenicity if given during pregnancy or within a month of conception. However, this funding restriction had the potential to create inequitable access barriers. This study was an audit examining the use of isotretinoin by deprivation level and ethnicity, in order to examine potential inequities in use.
  
  
  METHODS
  Dispensed prescription data for funded isotretinoin, for the year ending June 2008, held in a national repository was analysed using simple descriptive methods based on ethnicity and deprivation level. The same analysis was carried out for cyproterone acetate with ethinyloestradiol, another acne pharmaceutical available on prescription with no funding restrictions. There was demographic data on 60% of prescriptions based on the health identification number NHI.
  
  
  RESULTS
  People living in more deprived areas (as defined by NZDep Index) were less likely to use isotretinoin, as were Maori and Pacific people. The association with deprivation level was not present for cyproterone acetate with ethinyloestradiol, although disparities in use by ethnicity remained.
  
  
  CONCLUSIONS
  Given there is no evidence for lower rates of acne for Maori and Pacific people, the reasons may include financial and other barriers.
authors.affiliation: PHARMAC, P O Box 10-254, Wellington 6011, New Zealand. peter.moodie@pharmac.govt.nz
authors.forename: Peter
authors.initials: P
authors.lastname: Moodie
authors.forename: Richard
authors.initials: R
authors.lastname: Jaine
authors.forename: Jason
authors.initials: J
authors.lastname: Arnold
authors.forename: Mike
authors.initials: M
authors.lastname: Bignall
authors.forename: Scott
authors.initials: S
authors.lastname: Metcalfe
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
mesh_terms: D000152:Acne Vulgaris / Q000175:diagnosis / Q000188:drug therapy*; D000367:Age Factors; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003879:Dermatologic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006297:Health Services Accessibility / Q000191:economics; D054625:Healthcare Disparities; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D009520:New Zealand; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D003879:Dermatologic Agents; D015474:Isotretinoin