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Research

Cancer drug expenditure in British Columbia and Saskatchewan: a trend analysis

Reka Pataky, David A. Tran, Andrea Coronado, Riaz Alvi, Darryl Boehm, Dean A. Regier and Stuart Peacock
July 27, 2018 6 (3) E292-E299; DOI: https://doi.org/10.9778/cmajo.20170161
Reka Pataky
Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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David A. Tran
Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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Andrea Coronado
Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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Riaz Alvi
Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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Darryl Boehm
Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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Dean A. Regier
Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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Stuart Peacock
Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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    Figure 1:

    Unadjusted growth in number of users, prescriptions and expenditure in British Columbia and Saskatchewan, relative to 2006.

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    Figure 2:

    Growth in expenditure, adjusted for population growth and aging, in British Columbia and Saskatchewan, relative to 2006.

Tables

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    Table 1:

    Characteristics of unique dispensed systemic therapy prescriptions and systemic therapy recipients in British Columbia and Saskatchewan, 2006–2013

    CharacteristicBritish ColumbiaSaskatchewan
    No. (%) of prescriptions/recipients95% CINo. (%) of prescriptions/recipients95% CI
    Prescriptions2 100 947 (100.0)585 476 (100.0)
    Route of administration
     Oral688 522 (32.8)32.7 to 32.8202 071 (34.5)34.4 to 34.6
     Intravenous/other1 412 425 (67.2)67.2 to 67.3383 405 (65.5)65.4 to 65.6
    Indication
     Breast cancer573 376 (27.3)27.2 to 27.4124 971 (21.3)21.2 to 21.5
     Colorectal cancer420 224 (20.0)19.9 to 20.1176 161 (30.1)30.0 to 30.2
     Lung cancer106 866 (5.1)5.1 to 5.133 995 (5.8)5.7 to 5.9
     Prostate cancer197 864 (9.4)9.4 to 9.551 813 (8.8)8.8 to 8.9
     Other cancer802 617 (38.2)38.1 to 38.3198 536 (33.9)33.8 to 34.0
    Recipients103 680 (100.0)23 108 (100.0)
    Sex
     Male48 201 (46.5)46.2 to 46.811 240 (48.6)48.0 to 49.3
     Female55 479 (53.5)53.2 to 53.811 868 (51.4)50.7 to 52.0
    Age, yr, mean ± SD
    Age, yr64.9 ± 13.664.8 to 65.065.5 ± 13.365.3 to 65.7
     < 5013 619 (13.1)12.9 to 13.32733 (11.8)11.4 to 12.2
     50–5920 196 (19.5)19.2 to 19.74453 (19.3)18.8 to 19.8
     60–6928 377 (27.4)27.1 to 27.66184 (26.8)26.2 to 27.3
     70–7926 501 (25.6)25.3 to 25.86385 (27.6)27.1 to 28.2
     ≥ 8014 987 (14.4)14.2 to 14.73353 (14.5)14.1 to 15.0
    Cancer site
     Breast29 552 (28.5)28.2 to 28.86059 (26.2)25.7 to 26.8
     Colorectal9861 (9.5)9.3 to 9.72354 (10.2)9.8 to 10.6
     Lung7624 (7.4)7.2 to 7.52081 (9.0)8.6 to 9.4
     Prostate17 516 (16.9)16.7 to 17.14233 (18.3)17.8 to 18.8
     Other39 127 (37.7)37.4 to 38.08381 (36.3)35.6 to 36.9
    • Note: CI = confidence interval, SD = standard deviation.

    • View popup
    Table 2:

    Annual percent change by component in British Columbia*

    Route of administrationComponent; % change (95% CI)
    Total expenditure per capitaCancer incidence per capita†Users per incident casePrescriptions per userCost per prescription
    Total6.6 (5.4 to 7.7)−0.4 (−1.1 to 0.3)1.4 (0.8 to 2.1)2.2 (1.7 to 2.7)3.2 (2.5 to 3.9)
    Oral13.1 (10.7 to 15.6)−0.4 (−1.1 to 0.3)2.0 (1.4 to 2.6)3.0 (2.7 to 3.3)8.1 (6.0 to 10.2)
    Intravenous/other3.8 (2.7 to 5.0)−0.4 (−1.1 to 0.3)1.5 (0.8 to 2.2)1.5 (1.0 to 2.0)1.2 (0.6 to 1.9)
    Oral; cancer site
     Breast−11.4 (−17.8 to −4.5)1.1 (0.1 to 2.2)0.0 (−1.1 to 1.0)0.9 (0.4 to 1.3)−13.0 (−19.1 to −6.6)
     Colorectum5.7 (3.4 to 8.2)0.3 (−0.4 to 0.9)3.4 (1.7 to 5.1)2.8 (1.6 to 3.9)−0.7 (−1.6 to 0.3)
     Lung12.6 (9.7 to 15.6)−1.6 (−2.4 to −0.8)8.5 (6.3 to 10.7)1.3 (0.2 to 2.4)4.0 (2.7 to 5.4)
     Prostate26.4 (9.3 to 46.2)−4.0 (−5.7 to −2.4)3.3 (1.8 to 4.8)5.7 (4.3 to 7.2)20.6 (4.8 to 38.7)
     Other19.7 (15.1 to 24.4)0.5 (−0.3 to 1.3)3.2 (2.2 to 4.1)4.3 (3.6 to 4.9)10.7 (7.2 to 14.3)
    Intravenous/other; cancer site
     Breast−1.3 (−2.8 to 0.2)1.1 (0.1 to 2.2)0.9 (−0.3 to 2.0)−0.6 (−1.1 to −0.1)−2.6 (−3.4 to −1.8)
     Colorectum6.1 (3.0 to 9.3)0.3 (−0.4 to 0.9)2.6 (1.4 to 3.8)−0.2 (−1.0 to 0.7)3.4 (1.2 to 5.7)
     Lung11.7 (8.2 to 15.3)−1.6 (−2.4 to −0.8)1.0 (−0.4 to 2.4)0.7 (0.5 to 0.9)11.6 (8.5 to 14.7)
     Prostate−2.5 (−3.1 to −2.0)−4.0 (−5.7 to −2.4)2.8 (1.6 to 3.9)1.3 (1.0 to 1.6)−2.4 (−2.9 to −1.8)
     Other8.0 (6.5 to 9.5)0.5 (−0.3 to 1.3)2.3 (1.2 to 3.3)1.3 (0.5 to 2.1)3.7 (2.5 to 5.0)
    Oral; patient age, yr
     < 507.4 (−14.5 to 34.9)1.4 (0.4 to 2.3)1.9 (1.4 to 2.4)2.6 (2.2 to 3.0)1.3 (−0.2 to 2.9)
     50–5911.8 (−5.5 to 32.3)0.4 (−0.3 to 1.1)1.1 (0.4 to 1.9)3.0 (2.3 to 3.6)6.9 (3.7 to 10.2)
     60–6914.5 (−1.9 to 33.6)−0.7 (−1.7 to 0.3)2.3 (1.3 to 3.3)2.9 (2.4 to 3.5)9.4 (6.5 to 12.4)
     70–7916.1 (1.9 to 32.2)−0.4 (−1.1 to 0.2)1.7 (1.2 to 2.2)3.3 (3.0 to 3.7)11.0 (8.7 to 13.4)
     ≥ 8013.8 (0.9 to 28.3)−1.4 (−2.4 to −0.3)2.5 (1.5 to 3.5)3.1 (2.7 to 3.5)9.2 (7.0 to 11.5)
    Intravenous/other; patient age, yr
     < 502.0 (−14.0 to 20.9)1.4 (0.4 to 2.3)0.3 (−0.7 to 1.4)−0.5 (−1.1 to 0.2)0.8 (−0.2 to 1.8)
     50–592.2 (−9.3 to 15.2)0.4 (−0.3 to 1.1)0.6 (−0.3 to 1.6)0.1 (−0.6 to 0.7)1.2 (0.2 to 2.1)
     60–693.4 (−5.4 to 12.9)−0.7 (−1.7 to 0.3)1.5 (0.5 to 2.6)1.1 (0.7 to 1.6)1.4 (0.5 to 2.4)
     70–796.5 (−3.6 to 17.6)−0.4 (−1.1 to 0.2)1.7 (1.2 to 2.2)3.8 (3.3 to 4.3)1.3 (0.5 to 2.0)
     ≥ 805.8 (−10.3 to 24.8)−1.4 (−2.4 to −0.3)2.4 (1.5 to 3.4)4.4 (3.0 to 5.9)0.3 (−0.6 to 1.1)
    • Note: CI = confidence interval.

    • ↵* Standardized to pooled British Columbia and Saskatchewan population for 2013.

    • ↵† Does not change with route of administration.

    • View popup
    Table 3:

    Annual percent change by component in Saskatchewan*

    Route of administrationComponent; % change (95% CI)
    Total expenditure per capitaCancer incidence per capita†Users per incident casePrescriptions per useCost per prescription
    Total9.2 (7.2 to 11.2)0.2 (−0.3 to 0.6)1.9 (1.2 to 2.5)2.2 (1.8 to 2.6)4.7 (3.5 to 6.0)
    Oral16.5 (13.6 to 19.6)0.2 (−0.3 to 0.6)2.0 (1.1 to 2.9)3.2 (1.8 to 4.6)10.6 (7.8 to 13.5)
    Intravenous/other6.7 (4.6 to 8.8)0.2 (−0.3 to 0.6)2.0 (1.3 to 2.7)1.4 (0.7 to 2.1)2.9 (1.9 to 4)
    Oral; cancer site
     Breast10.8 (4.9 to 17.1)0.4 (−0.3 to 1.2)3.0 (1.3 to 4.7)2.0 (−0.3 to 4.2)5.3 (−0.2 to 11.0)
     Colorectum6.5 (2.7 to 10.4)4.4 (3.0 to 5.8)3.2 (0.0 to 6.5)8.0 (5.8 to 10.2)−8.4 (−10.5 to −6.2)
     Lung24.3 (4.0 to 48.5)0.3 (−0.7 to 1.3)4.0 (1.3 to 6.8)0.4 (−1.1 to 2.0)19.6 (0.8 to 41.9)
     Prostate31.9 (12.0 to 55.4)−4.9 (−7.3 to −2.4)3.2 (0.9 to 5.4)1.4 (−1.6 to 4.5)31.6 (12.9 to 53.4)
     Other16.9 (13.0 to 21.0)0.2 (−0.8 to 1.2)1.2 (0.1 to 2.4)4.2 (3.1 to 5.4)10.6 (6.6 to 14.6)
    Intravenous; cancer site
     Breast−2.8 (−6.0 to 0.5)0.4 (−0.3 to 1.2)−0.7 (−2.4 to 1.1)0.4 (−0.9 to 1.6)−2.8 (−4.6 to −0.9)
     Colorectum14.0 (7.8 to 20.6)4.4 (3.0 to 5.8)−1.5 (−4.3 to 1.3)0.2 (−0.8 to 1.2)10.6 (6.8 to 14.6)
     Lung11.8 (8.2 to 15.6)0.3 (−0.7 to 1.3)1.8 (−0.2 to 3.8)1.5 (0.2 to 2.9)7.8 (5.7 to 9.9)
     Prostate1.0 (−1.0 to 3.0)−4.9 (−7.3 to −2.4)6.1 (3.1 to 9.1)4.1 (2.9 to 5.3)−3.7 (−5.1 to −2.4)
     Other10.6 (8.8 to 12.4)0.2 (−0.8 to 1.2)4.1 (3.2 to 5.1)1.3 (0.0 to 2.7)4.6 (3.0 to 6.1)
    Oral; patient age, yr
     < 5014.1 (−11.4 to 46.9)1.6 (0.5 to 2.6)3.9 (3.0 to 4.9)1.9 (0.0 to 3.7)5.6 (3.9 to 7.4)
     50–5913.5 (−6.5 to 37.9)−0.7 (−1.9 to 0.6)3.5 (1.6 to 5.6)3.9 (1.9 to 5.9)6.5 (−0.6 to 14.2)
     60–6920.3 (3.7 to 39.5)−1.0 (−1.6 to −0.4)4.6 (3.2 to 6.0)3.6 (1.7 to 5.5)12.1 (9.4 to 14.9)
     70–7918.7 (4.2 to 35.2)1.0 (0.1 to 1.9)0.6 (−0.7 to 2.0)2.1 (0.6 to 3.5)14.5 (12.7 to 16.3)
     ≥ 8011.4 (−1.4 to 25.8)0.6 (−0.4 to 1.7)−4.0 (−5.9 to −2.2)1.6 (0.0 to 3.2)13.8 (8.0 to 19.9)
    Intravenous; patient age, yr
     < 506.3 (−12.1 to 28.6)1.6 (0.5 to 2.6)0.8 (−0.3 to 1.9)3.0 (1.2 to 4.7)0.8 (−1.0 to 2.7)
     50–597.4 (−4.3 to 20.4)−0.7 (−1.9 to 0.6)2.8 (1.4 to 4.3)2.2 (1.0 to 3.4)2.8 (1.6 to 4.0)
     60–696.5 (−1.6 to 15.1)−1.0 (−1.6 to −0.4)2.8 (1.3 to 4.4)1.0 (−0.4 to 2.4)3.5 (2.5 to 4.5)
     70–798.2 (−1.7 to 19.2)1.0 (0.1 to 1.9)1.8 (0.9 to 2.8)0.6 (−0.9 to 2.2)4.5 (3.2 to 5.8)
     ≥ 800.5 (−14.0 to 17.5)0.6 (−0.4 to 1.7)0.9 (−0.6 to 2.3)−2.3 (−4.6 to 0.1)1.2 (−2.1 to 4.7)
    • Note: CI = confidence interval.

    • ↵* Standardized to pooled British Columbia and Saskatchewan population for 2013.

    • ↵† Does not change with route of administration.

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Cancer drug expenditure in British Columbia and Saskatchewan: a trend analysis
Reka Pataky, David A. Tran, Andrea Coronado, Riaz Alvi, Darryl Boehm, Dean A. Regier, Stuart Peacock
Jul 2018, 6 (3) E292-E299; DOI: 10.9778/cmajo.20170161

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Cancer drug expenditure in British Columbia and Saskatchewan: a trend analysis
Reka Pataky, David A. Tran, Andrea Coronado, Riaz Alvi, Darryl Boehm, Dean A. Regier, Stuart Peacock
Jul 2018, 6 (3) E292-E299; DOI: 10.9778/cmajo.20170161
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