Claims for disease-modifying therapy by Alberta non-insured health benefits clients.

Cheryl Barnabe,Brenda Hemmelgarn,Bonnie Healy,Charles Weaselhead,Gilaad G Kaplan,Andrew Portolesi

doi:10.1186/s12913-016-1685-y

Abstract

BackgroundUncontrolled disease activity in inflammatory diseases of the joints, skin and bowel leads to morbidity and disability. Disease-modifying therapies are widely used to suppress this disease activity, but cost-coverage is variable. For Treaty First Nations and Inuit people in Canada without alternative private or public health insurance, cost-coverage for disease-modifying therapy is provided through Non-Insured Health Benefits (NIHB). Our objective was to describe the prevalence and patterns of treatment with disease-modifying therapy for the NIHB claimant population, and also examine adjuvant therapy (analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids) use.MethodsCases (n = 2512) were defined by ≥1 claim for a disease-modifying anti-rheumatic drug (DMARD) or biologic between 1999 and 2012 in the NIHB pharmacy claim database. The proportion of the population with claims for individual agents and drug classes annually was calculated to estimate annual incidence and prevalence rates for use of disease-modifying therapy, and the prevalence of use of individual DMARDs, biologics and adjuvants. Differences in the proportion accessing adjuvant therapies and median doses in the 6 months following initiation of disease-modifying therapies was estimated.ResultsThe incidence rate of treatment was calculated at an average of 127.5 cases per 100,000 population between 2001 and 2012, and the cumulative prevalence, accounting for patients lost to the database, increased and then stabilized at 1.3 % in the last three years of the study. Annual dispensation of methotrexate, combination DMARD therapy and biologic therapy approached 35 %, 19 %, and 10 % of the cohort respectively. A declining prevalence of claims for acetaminophen (28 % to 15 %) and anti-inflammatories (73 % to 63 %) occurred from 2000 to 2012, however corticosteroid (32 %) and opioid (65 %) dispensation remained stable. The proportion of patients with claims for NSAIDs (69.9 % to 61.1 %, p = 0.002), oral corticosteroids (45.4 % to 33.6 %, p < 0.001) and parenteral corticosteroids (16.2 % to 8.3 %, p = 0.002) decreased in the 6 months following biologic initiation.ConclusionsThe proportion of NIHB clients with active claims for disease-modifying therapy is lower than expected based on existing epidemiologic knowledge of the prevalence of inflammatory conditions in the First Nations and Inuit populations. These findings should be further explored in order to optimize treatment outcomes for NIHB claimants with inflammatory disease.

Highlights

Uncontrolled disease activity in inflammatory diseases of the joints, skin and bowel leads to morbidity and disability
An additional consideration is the ability to access medications, which is different for First Nations and Inuit patients with Treaty Status under the Indian Act compared to other Canadians, with the federal government being responsible for pharmaceutical drug cost-coverage through the Non-Insured Health Benefits (NIHB) program, if not otherwise available through private or provincial plans [17]
The incidence rate, reported as new cases under treatment per 100,000 population, included individuals meeting the case definition for the first time in each fiscal year excluding the run-in period. The denominator for both the cumulative prevalence and the incidence rate was the migration-adjusted population total registered in the province on March 31 of that year, accounting for patients lost to the database. ii) Proportional distribution of use of disease-modifying anti-rheumatic drug (DMARD) and/or biologics in prevalent cases: In clients under active treatment, the annual prevalence of drug use was calculated for DMARDs and/or biologics as therapeutic classes, as well as for individual agents in these classes, by examining paid claims

Summary

Introduction

Uncontrolled disease activity in inflammatory diseases of the joints, skin and bowel leads to morbidity and disability. For Treaty First Nations and Inuit people in Canada without alternative private or public health insurance, cost-coverage for disease-modifying therapy is provided through Non-Insured Health Benefits (NIHB). Inflammatory diseases of the joints (e.g. rheumatoid arthritis, spondyloarthropathies) [1], bowel (e.g. Crohn’s Disease, ulcerative colitis) [2,3,4] and skin (e.g. psoriasis) [5] are leading causes of disability in Canadian society. These chronic conditions are characterized by immunemediated inflammation of their respective target organs, along with systemic consequences that result in premature death. This information will contribute to the understanding of the quality of care provided to First Nations and Inuit patients requiring disease-modifying therapy

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