Out-of-pocket spending on drugs and pharmaceutical products and cost-related prescription non-adherence among Canadians with chronic disease.
BACKGROUND
Approximately one-third of Canadians' prescription medication costs are paid directly out-of-pocket. This study attempts to determine if out-of-pocket spending greater than 5% of household income on drugs and pharmaceutical products is associated with cost-related prescription non-adherence among people with cardiovascular-related chronic conditions.


METHODS
The data are from the survey on Barriers to Care for People with Chronic Health Conditions. Three categories of out-of-pocket spending on drugs and pharmaceutical products as a percentage of household income were identified: 0%, more than 0% to less than 5%, and 5% or more. Log-binomial regression was used to investigate associations between category of out-of-pocket spending and cost-related non-adherence.


RESULTS
In 2012, about 80% of people aged 40 or older who lived in British Columbia, Alberta, Saskatchewan or Manitoba and had cardiovascular-related chronic conditions reported out-of-pocket spending on drugs and pharmaceutical products; 4.8% reported out-of-pocket spending of at least 5% of their household income. These individuals were significantly older, more often lived in households with incomes less than $30,000, and more often reported multiple morbidities than did people whose out-of-pocket spending on drugs and pharmaceutical products was less than 5% of household income. When the results were adjusted for age and sex, people whose spending amounted to 5% or more of household income were almost three times as likely (prevalence rate ratio = 2.6) to report cost-related prescription non-adherence than were those spending less than 5%.


CONCLUSIONS
Spending at least 5% of household income on drugs and pharmaceutical products was significantly associated with cost-related prescription non-adherence. Additional data are required to determine if even lower levels of spending put individuals at risk of cost related non-adherence.
Health Analysis Division, Statistics Canada, Ottawa, Ontario.
Deirdre
D
Hennessy
Health Analysis Division, Statistics Canada, Ottawa, Ontario.
Claudia
C
Sanmartin
Ottawa Hospital Research Institute.
Paul
P
Ronksley
Department of Community Health Sciences, University of Calgary.
Rob
R
Weaver
Department of Community Health Sciences, University of Calgary.
Dave
D
Campbell
Department of Community Health Sciences, University of Calgary.
Braden
B
Manns
Department of Community Health Sciences, University of Calgary.
Marcello
M
Tonelli
Department of Community Health Sciences, University of Calgary.
Brenda
B
Hemmelgarn
D000328:Adult; D000368:Aged; D002170:Canada; D002908:Chronic Disease / Q000188:drug therapy*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000191:economics*; D011306:Prescription Fees / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
D055553:Prescription Drugs
Chronic disease; cost-related non-adherence; health policy; out-of-pocket expenditures; prescription drugs