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Background
In 2019, more than $34.5 billion was spent on prescription drugs in Canada. However, little is known about the distribution of this spending across medications and settings (outpatient and inpatient) over time. The objective of this paper is to describe the largest expenditures by medication class over time in inpatient and outpatient se...
Contexts in source publication
Context 1
... third place was amlodipine, with total spend of $207.9 million in 2001. In 2020, the drug with the greatest spend in the outpatient sector was infliximab, at $1.2 billion, followed by adalimumab at $970.1 million, and ustekinumab at $527 million (Table 1). Within the top 25 drugs purchased by inpatient settings in 2001, spending was greatest on erythropoietin alpha, at $91.2 million, followed by alteplase at $38.8 million, and cyclosporine at $32.6 million (Table 1). ...Context 2
... 2020, the drug with the greatest spend in the outpatient sector was infliximab, at $1.2 billion, followed by adalimumab at $970.1 million, and ustekinumab at $527 million (Table 1). Within the top 25 drugs purchased by inpatient settings in 2001, spending was greatest on erythropoietin alpha, at $91.2 million, followed by alteplase at $38.8 million, and cyclosporine at $32.6 million (Table 1). In 2020, the drug with the greatest spend in the inpatient sector was pembrolizumab at $361.6 million, followed by nivolumab at $253.0 million, and daratumumab at $218.0 million. ...Citations
... US medication pricing is complex and varies by care setting. Recent US and Canadian reports have shown increasing rates of prescription medication spending in both inpatient and outpatient settings (26)(27)(28). A US health insurance organization reported that for 10 specialty medications within the top 25 medications by 2019 Medicare Part B spending (9 intravenous immunotherapy agents, 1 intramuscular neuromuscular blocker), hospital and physician office charges were 108% and 22% higher, respectively, compared to specialty pharmacies (29). ...
Objectives:
Spine surgery is associated with early impairment of gastrointestinal motility, with postoperative ileus rates of 5-12%. A standardized postoperative medication regimen aimed at early restoration of bowel function can reduce morbidity and cost, and its study should be prioritized.
Methods:
A standardized postoperative bowel medication protocol was implemented for all elective spine surgeries performed by a single neurosurgeon from March 1, 2022 to June 30, 2022 at a metropolitan Veterans Affairs medical center. Daily bowel function was tracked and medications were advanced using the protocol. Clinical, surgical, and length of stay data are reported.
Results:
Across 20 consecutive surgeries in 19 patients, mean age was 68.9 years [standard deviation (SD) = 10; range 40-84]. Seventy-four percent reported preoperative constipation. Surgeries consisted of 45% fusion and 55% decompression; lumbar retroperitoneal approaches constituted 30% (10% anterior, 20% lateral). Two patients were discharged in good condition prior to bowel movement after meeting institutional discharge criteria; the other 18 cases all had return of bowel function by postoperative day (POD) 3 (mean = 1.8-days, SD = 0.7). There were no inpatient or 30-day complications. Mean discharge occurred 3.3-days post-surgery (SD = 1.5; range 1-6; home 95%, skilled nursing facility 5%). Estimated cumulative cost of the bowel regimen was $17 on POD 3.
Conclusions:
Careful monitoring of return of bowel function after elective spine surgery is important for preventing ileus, reducing healthcare cost, and ensuring quality. Our standardized postoperative bowel regimen was associated with return of bowel function within 3 days and low costs. These findings can be utilized in quality-of-care pathways.
... Biosimilars offer one potential avenue to decrease spending on biologics, and projections suggest that they could reduce drug expenditures by $215 billion globally between 2022 and 2026 (1). Despite this potential, biosimilar uptake has been low in some countries, including the US and Canada (6)(7)(8)(9)(10). ...
Objective
Uptake of biosimilars has been suboptimal in North America. This study was undertaken to quantify the impact of various policy interventions (namely, new start and switching policies) on uptake and spending on biosimilar infliximab and etanercept in British Columbia (BC), Canada.
Methods
We used administrative claims data to identify BC residents ≥18 years of age with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and/or plaque psoriasis who qualified for public drug coverage from January 2013 to November 2020. Using interrupted time series analysis, we studied the change in proportion spent on and prescriptions dispensed of biosimilar infliximab and etanercept out of the total amount per agent after new start and biosimilar switching policies were implemented.
Results
Our study included 208,984 individuals living with rheumatoid arthritis, ankylosing spondylitis, plaque psoriasis, and/or psoriatic arthritis, corresponding to 5,884 patients taking infliximab and etanercept. After the new start policy, we detected a small gradual increase in the proportion of dispensed biosimilar etanercept prescriptions of 0.65% per month (95% confidence interval [95% CI] 0.44, 0.85). The trend related to the proportion of total spending on biosimilar etanercept also increased (0.51% [95% CI 0.28, 0.73]). After the switching policy, there was a sustained increase in the proportion of dispensed biosimilar etanercept and infliximab prescriptions of 76.98% (95% CI 75.56, 78.41) and 58.43% (95% CI 52.11, 64.75), respectively. Similarly, there was a persistent increase in monthly spending on biosimilar etanercept and infliximab of 78.22% (95% CI 76.65, 79.79) and 71.23% (95% CI 66.82, 75.65), respectively.
Conclusion
We found that mandatory switching policies were much more effective than new starting policies for increasing the use of biosimilar medications.
