title: The appropriateness and persistence of testosterone replacement therapy in Ontario.
abstract: To examine the concordance between testosterone replacement therapy (TRT) use and established reimbursement criteria, as well as compare the persistence of use among available formulations (injectable, oral, topical gel, transdermal patch) among elderly men in Ontario, Canada.
  
  
  
  We conducted a retrospective cohort study of men aged 66 years or older in Ontario newly treated with testosterone between 1 January 2009 and 31 December 2012 using linked health administrative data. Continuous use was defined on the basis of prescription refills issued within 180 days of the preceding prescription. We studied men who received at least two consecutive TRT prescriptions. We estimated the prevalence of hypogonadism, human immunodeficiency virus, specialist visits and lab tests for serum testosterone prior to initiation of TRT to investigate concordance with prescribing criteria. We also performed a Kaplan-Meier analysis to test for differences in the median time to discontinuation among formulations.
  
  
  
  Among the 4797 men who received at least two TRT prescriptions, only 38.7% met the reimbursement criteria for use prior to initiating therapy. The median time to discontinuation differed significantly among formulations and was longest among recipients of oral TRT products (383 days), and lower for recipients of topical gels (319 days), injectable (283 days) and transdermal patches (160 days; Log-rank test p < 0.001).
  
  
  
  A large proportion of older men in Ontario do not appear to meet reimbursement criteria prior to commencing therapy, and many discontinue TRT within a year of initiation. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Diana
authors.initials: D
authors.lastname: Martins
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Yao
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Mina
authors.initials: M
authors.lastname: Tadrous
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.|St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000368:Aged; D015331:Cohort Studies; D020249:Hormone Replacement Therapy / Q000191:economics / Q000379:methods*; D006801:Humans; D007267:Injections; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence; D009864:Ontario; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies; D013739:Testosterone / Q000008:administration & dosage* / Q000191:economics; D013997:Time Factors
chemical_list: D013739:Testosterone
keywords: Hormone Replacement Therapy; hypogonadism; medication adherence; pharmacoepidemiology; testosterone