CMAJ • July 7, 2009; 181 (1-2). doi:10.1503/cmaj.081913.
© 2009 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Research

Long-term trends in use of and expenditures for cardiovascular medications in Canada

Cynthia A. Jackevicius, PharmD MSc, Jafna L. Cox, BA MD, Daniel Carreon, BSc, Jack V. Tu, MD PhD, Stéphane Rinfret, MD MSc, Derek So, MD, Helen Johansen, PhD, Dimitri Kalavrouziotis, MD MSc, Virginie Demers, MD, Karin Humphries, MBA DSc, Louise Pilote, MD PhD for the Canadian Cardiovascular Outcomes Research Team

From Western University of Health Sciences (Jackevicius, Carreon), Pomona, USA; the Institute for Clinical Evaluative Sciences (Jackevicius, Tu), Toronto, Ont.; University of Toronto (Jackevicius, Tu), Toronto, Ont.; Dalhousie University (Cox, Kalavrouziotis), Halifax, NS; Sunnybrook Health Sciences Centre (Tu), Toronto, Ont.; Laval Hospital–Quebec Heart and Lung Institute and Laval University (Rinfret), Québec City, Que.; University of Ottawa Heart Institute (So), Ottawa, Ont.; Statistics Canada (Johansen), Ottawa, Ont.; McGill University Medical Centre (Demers, Pilote), Montréal, Que.; and University of British Columbia (Humphries), Vancouver, BC

Correspondence to: Dr. Cynthia Jackevicius, Western University of Health Sciences, College of Pharmacy, 309 E Second St., Pomona CA 91766, USA; fax 909 469-5539; cjackevicius{at}westernu.edu

Background: Medication expenditures have become the fastest growing sector of costs within the Canadian health care system. Evaluation of the use of cardiovascular medications is important to determine the magnitude of the growth, to identify which medications dominate the landscape and to detect interprovincial differences in utilization. We describe long-term trends in the use of and expenditures for cardiovascular medications in Canada, by drug class and by province.

Methods: For these analyses, we used volume and expenditure data related to prescriptions for cardiovascular medications obtained from IMS Health Canada’s CompuScript Audit® database for the period 1996–2006. Here, we describe national and provincial patterns of utilization and expenditures for specified classes of cardiovascular medications.

Results: The use of cardiovascular medications increased sharply in Canada during the study period, with related costs rising by over 200% during this period to surpass $5 billion in 2006. Changes in population demographics, risk factors and inflation appeared to account for about two-thirds of the observed growth in expenditures. Use of newer medication classes (statins, angiotensin-receptor blockers, angiotensin-converting-enzyme inhibitors), for which patented brand name medications predominate, accounted for almost one-third of the cost increases. Interprovincial differences in total expenditures for cardiovascular drugs portrayed a descending gradient from east to west, with greatest variability for the newer drug classes.

Interpretation: Prescriptions and expenditures for cardiovascular medications in Canada escalated over the study period. Projected increases may reach potentially unsustainable levels. Greater emphasis on the use of cost-effective medications is required to limit further increases. Factors influencing interprovincial differences warrant further study.


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