TORONTO, Feb. 29, 2016–Wealthier seniors in Ontario were prescribed a new blood thinner for a common heart rhythm abnormality 1.5 times more often than poorer seniors when the drug was first approved by Health Canada, a new study has found.
However, that inequity disappeared when the new drug, dabigatran (marketed as Pradaxa), was covered by the Ontario Drug Benefit Program 18 months later, followed by other provincial drug plans.
Researchers from St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES) said their findings demonstrate that there are socioeconomic barriers to accessing new medications when they are not paid for by publicly funded drug plans and that provinces need to make timely decisions about which drugs to approve.
"We suspect this is not the only drug that was available sooner to those who could afford to pay for it," said Dr. Michelle Sholzberg, the lead author, who is a clinical hematologist at St. Michael's. "If that's the case, this is further support for creation of a national pharmacare plan."
In Ontario, dabigatran costs about 20 times as much as warfarin, the anticoagulant (blood thinner) commonly prescribed to reduce the risk of stroke and other blood clots. But Dr. Sholzberg said dabigatran is cost-effective relative to warfarin because patients taking dabigatran do not need to have their blood monitored as often and because dabigatran is associated with fewer serious bleeding complications than warfarin.
The study, published in PLOS ONE, reviewed anonymized health records held at ICES for nearly 35,000 seniors in Ontario being treated for nonvalvular atrial fibrillation, a common heart rhythm abnormality, between 2008 and 2012. The researchers grouped the patients by neighbourhood income levels. They adjusted for demographic variables, comorbid illnesses, medication-related variables and specialist visits.
"This study is an example of the delays in access that are disproportionately faced by seniors who may be struggling financially, highlighting the importance of timely reimbursement decisions by provinces when new drugs come on the market," said Dr. Andreas Laupacis, the study's senior scientist who is an adjunct scientist at ICES and executive director of the Li Ka Shing Knowledge Institute of St. Michael's Hospital. "The results of this study are also an argument for a publicly funded drug plan that covers Canadians of all ages, because the financial barriers to access we saw with seniors almost certainly also exist for those younger than 65 years of age."
About St. Michael's Hospital
St. Michael's Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ki Sheng International Healthcare Education Center, which make up the Li Ki Sheng Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
About the Institute for Clinical Evaluative Sciences
The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario
For more information or to interview Dr. Sholzberg, please contact:
Manager, Media Strategy,
St. Michael's Hospital
Phone: 416-864-6094 or 416-200-4087
Media Advisor, ICES
(o) 416-480-4780 or (c) 416-434-7763
Melissa Di Costanzo