Customize your JAMA Network experience by selecting one or more topics from the list below.
Tamblyn R, Laprise R, Hanley JA, et al. Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons. JAMA. 2001;285(4):421–429. doi:10.1001/jama.285.4.421
Author Affiliations: McGill University, Department of Medicine and Department of Epidemiology and Biostatistics, Montréal, Quebec.
Context Rising costs of medications and inequities in access have sparked calls
for drug policy reform in the United States and Canada. Control of drug expenditures
by prescription cost-sharing for elderly persons and poor persons is a contentious
issue because little is known about the health impact in these subgroups.
Objectives To determine (1) the impact of introducing prescription drug cost-sharing
on use of essential and less essential drugs among elderly persons and welfare
recipients and (2) rates of emergency department (ED) visits and serious adverse
events associated with reductions in drug use before and after policy implementation.
Design and Setting Interrupted time-series analysis of data from 32 months before and 17
months after introduction of a prescription coinsurance and deductible cost-sharing
policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy
cohort studies were conducted to estimate the impact of the drug reform on
Participants A random sample of 93 950 elderly persons and 55 333 adult
welfare medication recipients.
Main Outcome Measures Mean daily number of essential and less essential drugs used per month,
ED visits, and serious adverse events (hospitalization, nursing home admission,
and mortality) before and after policy introduction.
Results After cost-sharing was introduced, use of essential drugs decreased
by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and
by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential
drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%),
respectively. The rate (per 10 000 person-months) of serious adverse
events associated with reductions in use of essential drugs increased from
5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly
persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in
welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency
department visit rates related to reductions in the use of essential drugs
also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in
elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1)
and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control
cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due
to an increase in the proportion of recipients who reduced their use of essential
drugs. Reductions in the use of less essential drugs were not associated with
an increase in risk of adverse events or ED visits.
Conclusions In our study, increased cost-sharing for prescription drugs in elderly
persons and welfare recipients was followed by reductions in use of essential
drugs and a higher rate of serious adverse events and ED visits associated
with these reductions.
Create a personal account or sign in to: