BACKGROUND:Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in Canada. Most patients with COPD receive long-term treatment with long-acting anticholinergics (LAAC) and/or long-acting β2-agonists (LABA). Adverse events (AEs) are also likely during long-term treatment with these medications.OBJECTIVE:To evaluate the prevalence of AEs in COPD patients on LAAC and LABA in a real-world setting.METHODS:We conducted a cross-sectional study of patients enrolled in the Registre de Données en Santé Pulmonaire (RESP) database, which records information on Canadian patients with asthma or COPD. COPD Patients completed a questionnaire about AEs that may be associated with LAAC and/or LABA. The prevalence of AEs and the corresponding 95% CI were calculated for three groups of patients (LAAC + LABA, LAAC alone, and LABA alone).RESULTS:Most patients with COPD (n = 154) were current or ex-smokers. Over 50% of patients were overweight or obese, and had an annual family income of less or equal to $42,000. Dry mouth (55.2%, 40%, and 43.5%) and dry throat (33.6%, 26.7%, and 34.8%) occurred most of the time or always in the LAAC + LABA, LAAC, and LABA groups, respectively. Headache was reported by 17.4% of patients in the LABA group, but less than 11.2% in the other groups.CONCLUSION:AEs reported in this study deserve clinical attention because they may negatively affect quality of life and treatment adherence of COPD patients.

To compare adherence to prescribed medications between patients with differed and those with immediate reimbursement at the point of service among Quebecers (Canada) with private drug insurance. A retrospective cohort was constructed by selecting patients aged 18-64 years with private drug insurance from the reMed database between March 2008 and December 2012. An algorithm was developed to assess the patient’s reimbursement modality, i.e. the drug cost covered by the insurance company is reimbursed immediately at the point of service (immediate reimbursement) or at a later time (differed reimbursement). Adherence was measured with the proportion of days covered (PDC) over one year for new users of the five most dispensed classes of medications, i.e. statins, proton pump inhibitors, thyroid hormones, antidepressants, and antihypertensive medications. Linear regression models were used to estimate the adjusted mean difference of the PDC between the two groups for each drug class. The cohort included 6,494 patients with immediate and 1,950 patients with differed drug reimbursement. More than 40% of patients were 35-49 years, 26% were men and 85% were past or non-smokers. The mean PDC was 79.9 % for patients with immediate reimbursement and 89.3 % for patients with differed reimbursement among new users of statins. Corresponding figures were 48.3% and 45.1% for new users of proton pump inhibitors, 84.7% and 84.8% for new users of thyroid hormones, 67.1% and 66.8% for new users of antidepressants, and 68.4% and 73.5% for new users of antihypertensive medications. The results of the linear regression analyses showed no significant differences between patients with immediate and differed drug reimbursement. Patient’s adherence was low for several drug classes but appeared to be unaffected by differed reimbursement. The short period of time between the purchase of the medication and the reimbursement by the insurer might explain the results.

The impact of the type of drug insurance plan on costs of medications is not well known. We aimed to compare the costs of antidepressants and statins, two of the most prescribed drugs, in Québec patients who are covered by private and public drug insurance. Two matched cohort studies were conducted using prescription claims databases for Quebec residents with private (reMed) and public drug insurance (RAMQ). Patients were aged 18 to 64 years and filled at least one prescription for an antidepressant (Cohort 1) or a statin (Cohort 2) in monotherapy between December 2007 and September 2009. The average monthly costs (medication cost + dispensing fee) of antidepressants and statins per patient and the percent cost difference for a 30-day prescription for each antidepressant and each statin product were compared between patients with private and public drug insurance using t-tests and regressionn models. Cohort 1 included 194 privately and 1923 publicly insured patients while the corresponding figures for Cohort 2 were 174 and 1712, respectively. The average cost of antidepressants and statins per patient per month was significantly higher among privately-insured than publicly-insured patients [Cohort 1: $48.17±25.19 vs. $33.72±17.58, p<0.001; Cohort 2: $61.19±22.31 vs. $54.62±20.48$, p<0.001]. The cost of 30-day prescriptions for most individual drugs of antidepressants and statins was significantly more expensive for privately-insured patients than publicly-insured patients. Higher cost of antidepressants and statins observed in privately-insured patients might be due to different pharmacy payment requirements and the dispensing fee restrictions under the public plan. More research is need to investigate whehter or not this higer drug cost translates into lower patient's adherence and persistence to medications.