Anat Fisher1, Greg Carney2, Ken Bassett3, Neena L Chappell4. 1. Department of Anesthesiology, Pharmacology, & Therapeutics, University of British Columbia, Vancouver, BC, Canada. Electronic address: anat.fisher@ti.ubc.ca. 2. Department of Anesthesiology, Pharmacology, & Therapeutics, University of British Columbia, Vancouver, BC, Canada. 3. Department of Anesthesiology, Pharmacology, & Therapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada. 4. Centre on Aging and Department of Sociology, University of Victoria, Victoria, BC, Canada.
Abstract
BACKGROUND: In October 2007, British Columbia started to cover the cost of cholinesterase inhibitors (ChEIs)-donepezil, galantamine, and rivastigmine-for patients with mild to moderate dementia and prominent Alzheimer's disease. OBJECTIVES: To examine the impact of this policy on persistence with ChEIs. METHODS: A population-based cohort study was conducted using British Columbia administrative health data. We examined 45,537 new ChEI users aged 40 years and older between 2001 and 2012; 20,360 (45%) started the treatment after the coverage policy was launched. Patients were followed until treatment discontinuation, defined as a ChEI-free gap of 90 days, death, or December 2013. Persistence on ChEIs was estimated using survival analysis and competing risk approach. Hazards of discontinuation were compared using competing risk Cox regression with propensity adjustment. RESULTS: Patients who started ChEI therapy after the introduction of the coverage policy had a significantly longer persistence. Median ChEI persistence until discontinuation or death was 9.37 months (95% confidence interval [CI] 9.0-39.7) and 17.6 months (95% CI 16.9-18.3) in patients who started therapy before and after the new policy, respectively. The propensity-adjusted hazard ratio for discontinuing therapy was 0.91 (95% CI 0.88-0.94). Similar patterns were observed for persistence with the first ChEI (propensity-adjusted hazard ratio of 0.94; 95% CI 0.91-0.98). In rivastigmine users, the hazard ratio was insignificant (0.98; 95% CI 0.92-1.02). CONCLUSIONS: The British Columbia ChEI coverage policy was associated with significantly prolonged persistence with donepezil and galantamine, but not rivastigmine.
BACKGROUND: In October 2007, British Columbia started to cover the cost of cholinesterase inhibitors (ChEIs)-donepezil, galantamine, and rivastigmine-for patients with mild to moderate dementia and prominent Alzheimer's disease. OBJECTIVES: To examine the impact of this policy on persistence with ChEIs. METHODS: A population-based cohort study was conducted using British Columbia administrative health data. We examined 45,537 new ChEI users aged 40 years and older between 2001 and 2012; 20,360 (45%) started the treatment after the coverage policy was launched. Patients were followed until treatment discontinuation, defined as a ChEI-free gap of 90 days, death, or December 2013. Persistence on ChEIs was estimated using survival analysis and competing risk approach. Hazards of discontinuation were compared using competing risk Cox regression with propensity adjustment. RESULTS:Patients who started ChEI therapy after the introduction of the coverage policy had a significantly longer persistence. Median ChEI persistence until discontinuation or death was 9.37 months (95% confidence interval [CI] 9.0-39.7) and 17.6 months (95% CI 16.9-18.3) in patients who started therapy before and after the new policy, respectively. The propensity-adjusted hazard ratio for discontinuing therapy was 0.91 (95% CI 0.88-0.94). Similar patterns were observed for persistence with the first ChEI (propensity-adjusted hazard ratio of 0.94; 95% CI 0.91-0.98). In rivastigmine users, the hazard ratio was insignificant (0.98; 95% CI 0.92-1.02). CONCLUSIONS: The British Columbia ChEI coverage policy was associated with significantly prolonged persistence with donepezil and galantamine, but not rivastigmine.
Authors: Laura C Maclagan; Susan E Bronskill; Michael A Campitelli; Shenzhen Yao; Christoffer Dharma; David B Hogan; Nathan Herrmann; Joseph E Amuah; Colleen J Maxwell Journal: Can J Psychiatry Date: 2020-04-10 Impact factor: 4.356
Authors: Anat Fisher; Greg Carney; Ken Bassett; K Malcolm Maclure; Colin R Dormuth Journal: Pharmacoepidemiol Drug Saf Date: 2019-07-03 Impact factor: 2.890
Authors: Greg Carney; Ken Bassett; James M Wright; Malcolm Maclure; Nicolette McGuire; Colin R Dormuth Journal: Alzheimers Dement (N Y) Date: 2019-11-25