title: Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease.
abstract: Background. Antitumor necrosis factor (anti-TNF) therapy is a highly effective but costly treatment for inflammatory bowel disease (IBD).Methods. We conducted a retrospective cohort study of IBD patients who were prescribed anti-TNF therapy (2007-2014) in Ontario. We assessed if the insurance type was a predictor of timely access to anti-TNF therapy and nonroutine health utilization (emergency department visits and hospitalizations).Results. There were 268 patients with IBD who were prescribed anti-TNF therapy. Public drug coverage was associated with longer median wait times to first dose than private one (56 versus 35 days,P= 0.002). After adjusting for confounders, publicly insured patients were less likely to receive timely access to anti-TNF therapy compared with those privately insured (adjusted hazard ratio, 0.66; 95% CI: 0.45-0.95). After adjustment for demographic and clinical characteristics, publicly funded subjects were more than 2-fold more likely to require hospitalization (incidence rate ratio [IRR], 2.30; 95% CI: 1.19-4.43) and ED visits (IRR 2.42; 95% CI: 1.44-4.08) related to IBD.Conclusions. IBD patients in Ontario with public drug coverage experienced greater delays in access to anti-TNF therapy than privately insured patients and have a higher rate of hospitalizations and ED visits related to IBD.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Rumman
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Roberto
authors.initials: R
authors.lastname: Candia
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canada.
authors.forename: Justina J
authors.initials: JJ
authors.lastname: Sam
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Croitoru
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Silverberg
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: A Hillary
authors.initials: AH
authors.lastname: Steinhart
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Geoffrey C
authors.identifier: 0000-0001-7083-7429
authors.initials: GC
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D001691:Biological Therapy / Q000191:economics*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005765:Gastrointestinal Agents / Q000191:economics*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000191:economics; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha