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Research

The effects of catastrophic drug plan deductibles on older women's use of cardiovascular medicines: a retrospective cohort study

Steven G. Morgan, Emilie J. Gladstone, Deirdre Weymann and Nadia Khan
March 07, 2017 5 (1) E198-E204; DOI: https://doi.org/10.9778/cmajo.20160145
Steven G. Morgan
School of Population and Public Health, Faculty of Medicine (Morgan), University of British Columbia; School of Population and Public Health, Faculty of Medicine (Gladstone), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (Weymann), British Columbia Cancer Agency; Division of General Internal Medicine, Faculty of Medicine (Khan), University of British Columbia, Vancouver, BC
PhD
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Emilie J. Gladstone
School of Population and Public Health, Faculty of Medicine (Morgan), University of British Columbia; School of Population and Public Health, Faculty of Medicine (Gladstone), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (Weymann), British Columbia Cancer Agency; Division of General Internal Medicine, Faculty of Medicine (Khan), University of British Columbia, Vancouver, BC
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Deirdre Weymann
School of Population and Public Health, Faculty of Medicine (Morgan), University of British Columbia; School of Population and Public Health, Faculty of Medicine (Gladstone), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (Weymann), British Columbia Cancer Agency; Division of General Internal Medicine, Faculty of Medicine (Khan), University of British Columbia, Vancouver, BC
MA
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Nadia Khan
School of Population and Public Health, Faculty of Medicine (Morgan), University of British Columbia; School of Population and Public Health, Faculty of Medicine (Gladstone), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (Weymann), British Columbia Cancer Agency; Division of General Internal Medicine, Faculty of Medicine (Khan), University of British Columbia, Vancouver, BC
MScMD
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Article Figures & Tables

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    Table 1: Terms of enhanced and standard Fair PharmaCare assistance
    Household income, $Deductible, as percentage of household income, %Coinsurance paid by household after deductible is reached, %Threshold beyond which government pays all drug costs as percentage of household income, %
    Enhanced assistance for households with 1 or more member born in 1939 or earlier
    Less than 33 0000251.25
    33 000-50 0001252
    Over $50 0002253
    Standard assistance for all other households
    Less than 15 0000302
    15 000-30 0002303
    Over 30 0003304
    • View popup
    Table 2: Characteristics of study population, stratified by eligibility for enhanced fair PharmaCare
    CharacteristicStandard assistance, %*
    n = 28 539
    Enhanced assistance, %*
    n = 24 926
    Age*, yr 
        698961 (31.6)3315 (13.3)
        707458 (26.3)4212 (16.9)
        715615 (19.8)5085 (20.4)
        723828 (13.5)5708 (22.9)
        732496 (8.8)6605 (26.5)
    Health status†
        1-2 major ADGs12 421 (43.8)11 167 (44.8)
        ≥ 3 major ADGs1957 (6.9)1919 (7.7)
    ≥ 1 diagnoses of primary indications†  
        Antihypertensives16 618 (58.6)15 529 (62.3)
        Cholesterol drugs5615 (19.8)5284 (21.2)
    Income†, $
        0-14 999709 (2.5)698 (2.8)
        15 000-29 9993148 (11.1)3963 (15.9)
        30 000-32 999567 (2.0)1371 (5.5)
        33 000-42 9993290 (11.6)3614 (14.5)
        43 000-49 9992439 (8.6)2642 (10.6)
        50 000-56 9993431 (12.1)2418 (9.7)
        57 000-69 9994197 (14.8)2767 (11.1)
        ≥ 70 00010 550 (37.2)7478 (30.0)
    Fair PharmaCare†
        Registered for plan25 835 (91.1)23 929 (96.0)
    Ethnicity†
        Chinese1730 (6.1)2817 (11.3)
        South Asian1163 94.1)997 (4.0)
    Rural dwelling
        Rural2297 (8.1)2044 (8.2)
    Overall health care use
    Mean total cost of medical care, $11121167
    Mean no. of medical care visits16.817.7
    Mean total cost of hospital care, $10671112
    Share with 1 or more   admissions to hospital, no. (%)6267 (22.1)5558 (22.3)

    Note: ADG = aggregated diagnostic group.

    *Unless otherwise indicated.

    †Difference significant at p = 0.05.

      • View popup
      Table 3: Adjusted odds ratios for the likelihood of filling at least 1 prescription and adjusted difference in days of therapy per person filling at least 1 prescription for antihypertensive and cholesterol treatments
      CharacteristicExposure to treatmentDuration of treatment
      Antihypertensive agents
      Adjusted OR (95% CI)
      Cholesterol treatments
      Adjusted OR (95% CI)
      Antihypertensive agents
      β (95% CI)
      Cholesterol treatments
      β (95% CI)
      Age (69 = reference), yr
      701.01 (0.94 to 1.08)1.10 (1.03 to 1.17)2.1 (-9.1 to 13.3)-0.7 (-7.7 to 6.2)
      711.15 (1.07 to 1.24)1.10 (1.03 to 1.18)9.1 (-2.2 to 20.5)-3.5 (-10.5 to 3.6)
      721.14 (1.06 to 1.24)1.14 (1.06 to 1.22)17.6 (5.9 to 29.4)-2.1 (-9.4 to 5.2)
      731.19 (1.10 to 1.29)1.19 (1.11 to 1.28)14.5 (2.5 to 26.5)-2.1 (-9.5 to 5.3)
      Health: no. of major ADGs (0 = reference)
      1 to 21.30 (1.23 to 1.37)1.26 (1.20 to 1.32)14.7 (6.5 to 22.8)4.7 (-0.5 to 9.8)
      ≥ 31.34 (1.21 to 1.49)1.39 (1.28 to 1.52)-1.4 (-15.2 to 12.5)-5.6 (-14 to 2.7)
      Diagnoses of specific indications, EDC codes
      CAR14 or CAR15: Hypertension27.25 (25.86 to 28.72)90.3 (81.2 to 99.3)
      CAR01: cardiovascular signs and symptoms1.36 (1.28 to 1.46)6.7 (-2.3 to 15.6)
      CAR05: Congestive heart failure5.25 (4.35 to 6.35)66.5 (48.9 to 84.2)
      CAR07: Cardiomyopathy11.62 (5.73 to 23.56)48.5 (5.8 to 91.2)
      END06 or END07: type 1 diabetes13.24 (5.42 to 32.3)210.5 (111 to 309.9)
      END08 or END09: type 2 diabetes6.9 (6.46 to 7.38)117.9 (109.4 to 126.4)
      CAR03: Ischemic heart disease2.59 (2.34 to 2.87)2.68 (2.49 to 2.87)60.9 (49.4 to 72.4)10.6 (4.2 to 17.1)
      CAR10: Generalized atherosclerosis2.06 (1.54 to 2.76)2.08 (1.7 to 2.54)61.1 (29.5 to 92.7)15.6 (-0.8 to 31.9)
      CAR12: Acute myocardial infarction3.39 (2.01 to 5.7)2.62 (2.03 to 3.38)-21 (-56.4 to 14.4)-54.6 (-72.4 to -36.9)
      CAR11: Disorders of lipoid metabolism3.21 (3.02 to 3.4)-20.6 (-26.1 to -15.2)
      NUR05: Cerebrovascular disease2.3 (2.07 to 2.55)-3.1 (-12.2 to 6.01)
      Ethnicity (white/other = reference)
      Chinese0.63 (0.57 to 0.69)1.24 (1.14 to 1.34)-49.5 (-64 to -35)-3.2 (-11.4 to 5)
      South Asian0.83 (0.73 to 0.94)1.44 (1.30 to 1.60)-10.9 (-28.6 to 6.8)-17.4 (-27.4 to -7.3)
      Setting (urban/suburban = reference)
      Rural setting1.10 (1.01 to 1.21)0.94 (0.86 to 1.02)6.6 (-6.6 to 19.7)-0.4 (-8.9 to 8.2)
      Income (< 15 000 = reference), $
      15 000-29 9991.01 (0.86 to 1.20)1.19 (1.03 to 1.37)34.4 (10.6 to 58.2)5.6 (-8.7 to 19.9)
      30 000-32 9990.89 (0.73 to 1.09)1.15 (0.97 to 1.37)47.5 (18.5 to 76.4)-0.4 (-17.8 to 17)
      33 000-42 9990.99 (0.83 to 1.17)1.12 (0.97 to 1.30)52.6 (28.0 to 77.1)11.7 (-3.0 to 26.5)
      43 000-49 9990.96 (0.81 to 1.15)1.05 (0.90 to 1.23)46.6 (21.2 to 72.0)12.5 (-2.8 to 27.8)
      50 000-56 9991.00 (0.83 to 1.19)1.11 (0.95 to 1.30)44.8 (18.8 to 70.8)17.6 (2.0 to 33.3)
      57 000-69 9991.02 (0.86 to 1.22)0.96 (0.82 to 1.13)40.6 (14.8 to 66.4)19.3 (3.7 to 34.9)
      ≥ 70 0000.93 (0.78 to 1.10)0.89 (0.77 to 1.03)35.5 (10.9 to 60.1)23.6 (8.8 to 38.4)
      PharmaCare assistance (standard = reference), $
      Enhanced, < 50 0001.15 (1.06 to 1.24)1.13 (1.06 to 1.21)7.5 (-3.6 to 18.7)6.1 (-0.7 to 12.8)
      Enhanced, > 50 0000.98 (0.91 to 1.04)1.08 (1.01 to 1.15)4.1 (-6.2 to 14.5)-0.3 (-6.7 to 6.2)

      Note: Bolded estimates are statistically significant (p < 0.05). ADG = aggregated diagnostic group, CI = confidence interval, ECD = episode-specific disease category, OR = odds ratio.

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      The effects of catastrophic drug plan deductibles on older women's use of cardiovascular medicines: a retrospective cohort study
      Steven G. Morgan, Emilie J. Gladstone, Deirdre Weymann, Nadia Khan
      Mar 2017, 5 (1) E198-E204; DOI: 10.9778/cmajo.20160145

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      The effects of catastrophic drug plan deductibles on older women's use of cardiovascular medicines: a retrospective cohort study
      Steven G. Morgan, Emilie J. Gladstone, Deirdre Weymann, Nadia Khan
      Mar 2017, 5 (1) E198-E204; DOI: 10.9778/cmajo.20160145
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