Claims for disease-modifying therapy by Alberta non-insured health benefits clients

Abstract

BackgroundUncontrolled disease activity in inflammatory diseases of the joints, skin and bowel leads to morbidity and disability. Disease-modifying therapies are widely used to suppress this disease activity, but cost-coverage is variable. For Treaty First Nations and Inuit people in Canada without alternative private or public health insurance, cost-coverage for disease-modifying therapy is provided through Non-Insured Health Benefits (NIHB). Our objective was to describe the prevalence and patterns of treatment with disease-modifying therapy for the NIHB claimant population, and also examine adjuvant therapy (analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids) use.MethodsCases (n = 2512) were defined by ≥1 claim for a disease-modifying anti-rheumatic drug (DMARD) or biologic between 1999 and 2012 in the NIHB pharmacy claim database. The proportion of the population with claims for individual agents and drug classes annually was calculated to estimate annual incidence and prevalence rates for use of disease-modifying therapy, and the prevalence of use of individual DMARDs, biologics and adjuvants. Differences in the proportion accessing adjuvant therapies and median doses in the 6 months following initiation of disease-modifying therapies was estimated.ResultsThe incidence rate of treatment was calculated at an average of 127.5 cases per 100,000 population between 2001 and 2012, and the cumulative prevalence, accounting for patients lost to the database, increased and then stabilized at 1.3 % in the last three years of the study. Annual dispensation of methotrexate, combination DMARD therapy and biologic therapy approached 35 %, 19 %, and 10 % of the cohort respectively. A declining prevalence of claims for acetaminophen (28 % to 15 %) and anti-inflammatories (73 % to 63 %) occurred from 2000 to 2012, however corticosteroid (32 %) and opioid (65 %) dispensation remained stable. The proportion of patients with claims for NSAIDs (69.9 % to 61.1 %, p = 0.002), oral corticosteroids (45.4 % to 33.6 %, p < 0.001) and parenteral corticosteroids (16.2 % to 8.3 %, p = 0.002) decreased in the 6 months following biologic initiation.ConclusionsThe proportion of NIHB clients with active claims for disease-modifying therapy is lower than expected based on existing epidemiologic knowledge of the prevalence of inflammatory conditions in the First Nations and Inuit populations. These findings should be further explored in order to optimize treatment outcomes for NIHB claimants with inflammatory disease.

Qualitative Study of Treatment Preferences for Rheumatoid Arthritis and Pharmacotherapy Acceptance: Indigenous Patient Perspectives

“…In Alberta, Canada, the First Nations population has a 3‐fold higher prevalence of rheumatoid arthritis (RA) than the non–First Nations population and are less likely to receive specialist care . System barriers (including an unresponsive specialist system ) or differences in the ability to access required therapies may contribute to worse RA outcomes, including lower rates of remission and worse patient‐reported outcomes . Other factors that contribute to worse outcomes in RA may exist, including the application of a biomedical model at the expense of a patient‐centric holistic model and perpetuation of health care providers’ belief that indigenous patients do not “buy‐in” to mainstream health services and have a low understanding of their value .…”

Informing the GRADE evidence to decision process with health equity considerations: demonstration from the Canadian rheumatoid arthritis care context

“…As treatment is guided by subspecialists, access to care may be challenging for those in rural and remote locations 8 . Formulary policies may impede access to necessary medications 9 . Instigated by our conviction that guidelines updates for our national rheumatology association should address equity, we undertook the development of an Equity EtD Framework contextualized to the Canadian rheumatology practice setting, specifically in rheumatoid arthritis.…”

“There are still a lot of things that I need”: a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic

“…Inflammatory arthritis and osteoarthritis are the most common chronic diseases affecting Indigenous peoples [ 8 ] and their disabling effects are distinctly higher than in the rest of the population [ 9 ]. In the province of Alberta, these health inequities are in part related to difficulties in accessing sufficient healthcare [ 10 ], specialists [ 11 ] and medications [ 12 ]. A rheumatology outreach clinic, embedded in a primary healthcare center, was established in 2010 in the Indigenous rural reserve of Siksika Nation, Alberta, as an Indigenous rheumatology model of care to mitigate some of these inequities.…”