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Trends in Utilization of Services with Introduction of Drug Coverage for Cholinesterase Inhibitors (ChEI)

Study analyzing the impact of drug coverage for ChEI on utilization of healthcare services for Alzheimer's disease. Preliminary findings suggest that drug marketing and insurance policy changes influence the rate of diagnosis of Alzheimer's Disease.

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Trends in Utilization of Services with Introduction of Drug Coverage for Cholinesterase Inhibitors (ChEI)

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  1. Trends in utilization of services associated with introduction of drug coverage for Cholinesterase Inhibitors (ChEI) Malcolm Maclure, ScD, Professor Wendy Smith and Colin Dormuth, Assistant Professor Dept Anesthesiology, Pharmacology and Thereapeutics, UBC

  2. Disclosures Dr. Maclure is a half-time employee of BC Ministry of Health: Co-Director of Research and Evidence Development in Pharmaceutical Services Division. Dr. Dormuth receives partial funding support from Pharmaceutical Services Division.

  3. Relation among ADTI studies • Utilization & Cost Study cohort • 76,094 new ADRD dx: Nov 1, 2002 to Oct 31, 2009 • Ever-users of ChEI in cohort: 14,327 (19%) • Clinical Epidemiology cohort:Nov 2007-Sep 2011 • >18,000 patients approved for Special Authority Contacts: 2254 Triage for eligibility: 1124 • Caregiver Appraisal Study: 1071 enrolled • Seniors Medication Study: 198 indeterminate • CLIMAT: ~100

  4. Utilization Cohort Study Design Policy began CONTROL BEFORE AFTER AFTER BEFORE

  5. Policy impact: Use of ChEIs up 13% Policy began

  6. Coinciding drop in use of antipsychotics Policy began

  7. No impact on use of MD services Policy began

  8. No impact on rate of entry to Long-Term or Palliative Care Policy began

  9. Probably no reduced mortality Policy began

  10. No reduction in hospital admissions Policy began

  11. Policy increased AD diagnosis rate Policy began

  12. Drug use trends are greatly influenced by marketing Policy began

  13. Drug use trends are greatly influenced by marketing Policy began

  14. Fairly stable incidence rate of new users before policy Policy began

  15. Incidence rate of ADRD drug initiation, by age group Policy began

  16. Antipsychotic incidence rate was declining for other reasons Not zero Policy began

  17. Antipsychotic incidence rate was declining for other reasons Policy began

  18. Preliminary conclusions • The Alzheimer’s Drug Therapy Initiative has not yet been found to be associated with an overall reduction in healthcare utilization • Trend analysis, comparing the Policy Cohort with Historical Controls, is made more difficult by surges in marketing of new drugs • Drug marketing and drug insurance policy changes seem to influence rate of diagnosis of Alzheimer’s Disease.

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