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Research

The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey

Michael R. Law, Lucy Cheng, Ashra Kolhatkar, Laurie J. Goldsmith, Steven G. Morgan, Anne M. Holbrook and Irfan A. Dhalla
February 13, 2018 6 (1) E63-E70; DOI: https://doi.org/10.9778/cmajo.20180008
Michael R. Law
Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.
PhD
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Lucy Cheng
Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.
MSc
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Ashra Kolhatkar
Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.
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Laurie J. Goldsmith
Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.
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Steven G. Morgan
Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.
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Anne M. Holbrook
Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.
MDPharmD
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Irfan A. Dhalla
Centre for Health Services and Policy Research (Law, Cheng, Kolhatkar); School of Population and Public Health (Law, Cheng, Kolhatkar, Morgan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; Division of Clinical Pharmacology and Toxicology (Holbrook), Department of Medicine, McMaster University, Hamilton, Ont.; Health Quality Ontario (Dhalla); Li Ka Shing Knowledge Institute (Dhalla), St. Michael's Hospital; Institute for Clinical Evaluative Sciences (Dhalla), Toronto, Ont.
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Article Figures & Tables

Tables

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    Table 1: Sociodemographic and health characteristics and prevalence of cost-related nonadherence among respondents to the Canadian Community Health Survey, January-June 2016
    VariableNo. of respondentsWeighted proportion of total population (95% CI)Weighted proportion with cost-related nonadherence (95% CI)
    Overall28 091-5.53 (5.06-6.00)
    Sex
        Female15 02450.66 (50.66-50.66)6.50 (5.81-7.19)
        Male13 06749.34 (49.34-49.34)4.54 (3.92-5.16)
    Age, yr
        12-1725118.69 (8.43-8.95)2.06 (1.32-2.80)
        18-34523425.21 (24.96-25.47)7.65 (6.47-8.82)
        35-44356814.70 (14.20-15.20)6.04 (4.77-7.31)
        45-54404616.79 (16.08-17.51)5.64 (4.51-6.76)
        55-64489716.13 (15.63-16.64)5.01 (4.00-6.01)
        65-74461511.49 (11.17-11.80)4.77 (3.80-5.74)
        ≥ 7532206.98 (6.67-7.30)3.35 (2.35-4.36)
    Self-reported health status
        Excellent599623.99 (23.13-24.86)2.88 (2.10-3.66)
        Very good10 22137.32 (36.41-38.23)3.64 (3.07-4.22)
        Good801627.39 (26.51-28.28)6.90 (5.92-7.88)
        Fair27778.04 (7.54-8.54)12.54 (10.21-14.87)
        Poor10363.11 (2.78-3.45)18.42 (14.56-22.28)
    No. of chronic conditions
        012 33950.54 (49.61-51.46)3.18 (2.67-3.69)
        1740126.05 (25.20-26.89)6.01 (5.09-6.93)
        2438012.83 (12.24-13.42)7.32 (5.96-8.67)
        323286.24 (5.86-6.63)12.43 (9.89-14.97)
        ≥ 416434.34 (3.98-4.70)14.82 (12.31-17.34)
    Ethnic background
        South Asian5494.41 (3.89-4.93)6.60 (3.01-10.18)
        East Asian6714.33 (3.84-4.83)3.83 (2.22-5.43)
        Aboriginal13493.61 (3.27-3.95)10.94 (7.95-13.92)
        White23 02972.25 (71.30-73.21)5.13 (4.66-5.61)
        Other249315.39 (14.58-16.21)6.30 (4.76-7.84)
    Total household income, $
        < 20 00026757.11 (6.62-7.60)11.14 (8.85-13.43)
        20 000-39 999494013.76 (13.13-14.39)9.44 (7.92-10.95)
        40 000-59 999446914.03 (13.40-14.66)7.03 (5.74-8.32)
        60 000-79 999363112.93 (12.27-13.60)5.56 (4.27-6.84)
        80 000-99 999305611.52 (10.90-12.14)4.81 (3.48-6.15)
        100 000-149 999490519.87 (19.07-20.68)3.57 (2.69-4.45)
        ≥ 150 000441520.78 (19.94-21.62)2.27 (1.59-2.94)
    Education
        Secondary school623422.67 (21.83-23.52)6.69 (5.59-7.8)
        Postsecondary15 00156.66 (55.70-57.61)5.19 (4.57-5.82)
    Less than secondary school646419.02 (18.40-19.64)5.11 (4.17-6.05)
    Prescription drug insurance
        Employer plan13 57351.58 (50.60-52.55)3.44 (2.92-3.96)
        Association plan24187.93 (7.41-8.45)3.86 (2.65-5.07)
        Government plan589616.56 (15.90-17.23)7.13 (6.09-8.18)
        None533119.46 (18.65-20.26)11.29 (9.69-12.88)
    No. of prescription drugs in prior 12 mo
        0910836.48 (35.57-37.40)0.88 (0.63-1.13)
        1 or 2821230.70 (29.78-31.63)6.96 (6.01-7.92)
        3 or 4519516.11 (15.44-16.79)8.47 (7.29-9.65)
        ≥ 5497613.54 (12.98-14.09)12.00 (10.23-13.76)
    Out-of-pocket prescription drug spending in prior 12 mo, $
        012 13347.34 (46.37-48.31)1.68 (1.35-2.01)
        1-200872530.06 (29.20-30.92)6.30 (5.42-7.19)
        201-50031859.56 (9.04-10.08)13.50 (11.10-15.90)
        501-100017224.79 (4.44-5.14)15.37 (12.31-18.43)
        > 100011493.19 (2.88-3.50)17.96 (14.34-21.58)
    Province
        British Columbia375713.25 (13.25-13.25)8.11 (6.74-9.47)
        Alberta347611.53 (11.53-11.53)5.73 (4.55-6.91)
        Saskatchewan11872.95 (2.95-2.95)5.69 (3.38-8.01)
        Manitoba13563.39 (3.39-3.39)5.51 (3.75-7.27)
        Ontario873339.00 (39.00-39.00)5.77 (4.85-6.68)
        Quebec616023.18 (23.18-23.18)3.70 (3.01-4.39)
        New Brunswick9002.11 (2.11-2.11)4.83 (3.05-6.60)
        Nova Scotia12372.66 (2.66-2.66)5.22 (3.55-6.89)
    Prince Edward Island4490.41 (0.41-0.41)6.08 (3.66-8.51)
    Newfoundland and Labrador8361.50 (1.50-1.50)4.51 (2.68-6.34)

    Note: CI = confidence interval.

      • View popup
      Table 2: Types of drugs foregone and cost of prescriptions foregone owing to cost-related nonadherence
      VariableWeighted total (95% CI)Weighted proportion
      of population with cost-related nonadherence (95% CI)
      Condition treated by drugs foregone in prior 12 mo
      Depression, anxiety or other mental health condition331 866 (268 881-394 851)21.43 (17.99-24.87)
      Arthritis or chronic pain252 590 (190 989-314 192)16.31 (12.68-19.76)
      Heart disease, cholesterolemia or high blood pressure244 306 (191 779-296 833)15.78 (12.60-18.95)
      Infection227 983 (166 112-289 855)14.72 (11.16-18.28)
      Gut problems (e.g., peptic ulcer, heartburn, bowel disease)175 502 (136 984-214 020)11.33 (8.96-13.71)
      Asthma or chronic obstructive pulmonary disease152 800 (119 051-186 548)9.87 (7.78-11.95)
      Diabetes127 437 (93 474-161 399)8.23 (6.13-10.33)
      Cancer9267 (4604-12 931)0.60 (0.29-0.90)
      Other658 065 (573 155-742 975)42.49 (38.56-46.42)
      Cost of most recent foregone prescription, $
      1-25164 219 (120 569-207 868)11.31 (8.54-14.08)
      26-50263 747 (214 091-313 403)18.16 (15.20-21.13)
      51-200749 933 (650 338-849 528)51.65 (47.18-56.12)
      201-1000236 765 (181 154-292 376)16.31 (12.75-19.86)
      > 100037 326 (24 227-50 426)2.57 (1.69-3.45)

      Note: CI = confidence interval.

        • View popup
        Table 3: Additional use of health care services resulting from cost-related nonadherence
        ServiceWeighted total (95% CI)Weighted proportion of total population (95% CI)Weighted proportion of population with cost-related nonadherence (95% CI)
        Physician visit303 341 (242 651-364 032)0.99 (0.79-1.19)19.50 (16.11-22.89)
        Emergency department93 295 (63 451-123 139)0.31 (0.21-0.40)6.00 (4.18-7.82)
        Hospital stay26 423 (14 502-38 345)0.09 (0.05-0.13)1.70 (0.94-2.46)
        Any of the above374 461 (308 263-440 659)1.23 (1.01-1.44)24.08 (20.56-27.59)

        Note: CI = confidence interval.

          • View popup
          Table 4: Expenditure areas in which trade-offs were made in order to afford prescription drugs
          AreaWeighted total (95% CI)Weighted proportion of total population (95% CI)
          Leisure or vacation836 885 (735 937-937 832)2.74 (2.41-3.07)
          Food729 706 (637 166-822 246)2.39 (2.08-2.69)
          Car, public transit or other transportation costs375 774 (307 488-444 060)1.23 (1.01-1.45)
          Other health care expenses for self or anyone else in household238 611 (180 067-297 155)0.78 (0.59-0.97)
          Heat238 178 (182 771-293 584)0.78 (0.60-0.96)
          Housing206 056 (147 832-265 289)0.67 (0.48-0.86)
          Other expenses not already mentioned297 882 (231 905-363 858)0.97 (0.76-1.19)
          Any of the above1 447 183 (1 313 582-1 580 785)4.73 (4.30-5.17)

          Note: CI = confidence interval.

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          The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey
          Michael R. Law, Lucy Cheng, Ashra Kolhatkar, Laurie J. Goldsmith, Steven G. Morgan, Anne M. Holbrook, Irfan A. Dhalla
          Jan 2018, 6 (1) E63-E70; DOI: 10.9778/cmajo.20180008

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          The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey
          Michael R. Law, Lucy Cheng, Ashra Kolhatkar, Laurie J. Goldsmith, Steven G. Morgan, Anne M. Holbrook, Irfan A. Dhalla
          Jan 2018, 6 (1) E63-E70; DOI: 10.9778/cmajo.20180008
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