Canadian spending on heart drugs doubles to more than $5 billion a year

Drugs are the fastest-growing area within the Canadian healthcare system. One in five prescriptions filled nationwide is for a cardiac medication, making it the most common prescription Canadians are receiving. A study led by researchers at the Institute for Clinical Evaluative Sciences (ICES) and the Canadian Cardiovascular Outcomes Research Team (CCORT) has found a 200 per cent increase in cardiovascular medication costs in just one decade from 1996 to 2006. Information from 2006, the most current data available, demonstrates total annual costs for cardiovascular medications exceeded $5 billion, with statins (which lower cholesterol levels in the blood) accounting for almost 40 per cent of the total.

But there are benefits from this growing expenditure. “The recent decrease in death and hospitalization rates from heart disease in Canada over the last 10 years may be partly explained by the increase in cardiac medication use that we observed in our study. But greater use of older, evidence-based therapies and healthier lifestyles may provide an opportunity to continue achieving these important health gains while slowing the rate of the rise in cardiac drug costs,” says Dr. Cynthia Jackevicius, lead author and scientist at ICES.

The nationwide study done between 1996 and 2006 found:

• The costs for cardiac medications increased by more than 200 per cent, exceeding $5 billion per year in 2006.
• Increasing age, risk factors (such as hypertension and diabetes), and inflation accounts for about two thirds of the growth in costs.
• Use of new, relatively expensive medications, such as statins, ACE inhibitors, and angiotensin receptor blockers accounted for almost one third of the cost increase.
• The largest difference in prescribing between provinces was seen in these new medications.
• If the use of cardiac medications continues to increase at the same rate as seen in this study, the costs could reach $10.6 billion in 2020.

“Given this level of growth in medication costs, ensuring that medications are used cost-effectively is essential,” says Jackevicius. “This should include negotiating lower prices for generic drugs similar to that seen in many other developed countries, and also developing strategies to encourage physicians in Canada to prescribe lower cost but equally effective alternatives.”

“We need to develop a more comprehensive system in Canada to evaluate the clinical indications and outcomes of patients receiving these drugs in order to optimize the use of cardiac medications in the Canadian healthcare system,” says Dr. Jack Tu, study co-author and senior scientist at the Institute for Clinical Evaluative Sciences and Canada Research Chair in Health Services Research.

Author affiliations: ICES (Jackevicius, Tu); University of Toronto (Jackevicius, Tu); University Health Network (Jackevicius,); Western University of Health Sciences (Jackevicius, Carreon); Dalhousie University (Cox, Jafna, Kalavrouziotis); Sunnybrook Health Sciences Centre (Tu); Laval Hospital-Quebec Heart and Lung Institute and Laval University (Rinfret); University of Ottawa Heart Institute (So); Statistics Canada (Johansen); McGill University Medical Centre (Demers, Pilote); University of British Columbia (Humphries).

The study “Long-term trends in cardiovascular medication utilization and expenditures in Canada” is in the July 7, 2009 issue of CMAJ (Canadian Medical Association Journal).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

The study was conducted by researchers participating in the CCORT initiative including researchers from the Institute for Clinical Evaluative Sciences, University Health Network, University of Toronto, Toronto, Ontario, Western University of Health Sciences in Ponoma, USA; Dalhousie University; Laval University; University of Ottawa Heart Institute; Statistics Canada; McGill University and University of British Columbia. This study was funded a Canadian Institutes of Health Research (CIHR) Team Grant in Cardiovascular Outcomes Research to the Canadian Cardiovascular Outcomes Research Team.

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