title: Variations in costs and use of provincially-funded testosterone replacement therapy across Canada: a population-based study.
abstract: BACKGROUND
  Provincial drug-program policies for the reimbursement of testosterone replacement therapy (TRT) vary across Canada, which may result in marked regional variability in use.
  
  
  METHODS
  We conducted a population-based cross-sectional analysis of provincially funded TRT spending and utilization in eight provinces across Canada in 2012. We reported the annual cost per user, total cost, and rate of use of TRT overall and by formulation.
  
  
  RESULTS
  We identified 23,544 provincially-funded recipients of TRT in 2012 in the eight provinces studied. Average annual cost per person varied by 3-fold, ranging from $173 (Prince Edward Island) to $485 (Ontario). Ontario also had the highest rate of use (1,105 users per 100,000 eligible) and the most liberal listing. Provinces with more restricted access (Alberta, British Columbia, and PEI) had lower annual costs per user ($293, $206, $173, respectively).
  
  
  CONCLUSIONS
  Differing reimbursement policies for TRT products across Canada are likely contributing to variation in the rate of use and cost per recipient.
authors.affiliation: a Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada.|b The Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.|c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.
authors.forename: Mina
authors.initials: M
authors.lastname: Tadrous
authors.affiliation: b The Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.
authors.forename: Diana
authors.initials: D
authors.lastname: Martins
authors.affiliation: d Canadian Institute for Health Information , Ottawa , ON , Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lee
authors.affiliation: a Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada.|c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Knowles
authors.affiliation: a Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada.|c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.|e The Sunnybrook Research Institute , Toronto , ON , Canada.|f Department of Medicine , St. Michael's Hospital , Toronto , ON , Canada.|g Department of Medicine , University of Toronto , Toronto , ON , Canada.|h Departments of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.affiliation: b The Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.|g Department of Medicine , University of Toronto , Toronto , ON , Canada.|h Departments of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada.|i Departments of Pediatrics , University of Toronto , Toronto , ON , Canada.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.affiliation: a Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada.|b The Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.|c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.|h Departments of Health Policy, Management, and Evaluation , University of Toronto , Toronto , ON , Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
mesh_terms: D002170:Canada; D003430:Cross-Sectional Studies; D016527:Drug Costs; D006291:Health Policy / Q000191:economics; D020249:Hormone Replacement Therapy / Q000191:economics / Q000379:methods*; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008297:Male; D012051:Reimbursement Mechanisms / Q000191:economics*; D013739:Testosterone / Q000008:administration & dosage* / Q000191:economics
chemical_list: D013739:Testosterone
keywords: Drug utilization; cost control; health expenditure; health policy; testosterone