CMAJ: Cost of CV meds increase 200% to $5B in Canada
The number of prescriptions in Canada for cardiovascular (CV) medications has been increasing over the past decade, with a 200 percent increase in costs, according to a study published July 6 in the Canadian Medical Association Journal. In 2006, total costs of CV medications exceeded $5 billion, with statins accounting for almost 40 percent of the expenditure.

The authors wrote that cardiovascular disease is the leading cause of premature death and disability in Canada, exerting a significant societal burden. CV drugs are the most commonly prescribed medications in the country, and expenditures outpace overall drug prescription increases. They noted that if the trend continues, costs are expected to rise to approximately $10.6 billion in 2020 and could threaten the sustainability of public drug insurance programs.

For example, Canadians spent 17 cents of every healthcare dollar on medication in 2007, representing a 16 percent increase in proportional healthcare spending since 1997. Factors such as population growth, increasing rates of hypertension, pharmaceutical cost inflation and an aging population only partly explain the significant increase in costs.

The investigators found that variations exist across provinces, with higher costs in the east. They said that increases in prescription volume and use of new and more expensive CV medications also are fuelling this rise. However, this practice needs to be examined as some older, established drugs may be the most cost effective to use.

"We found that the medication classes with the greatest increases in prescriptions dispensed and associated expenditures were angiotensin receptor blockers, antiplatelets, statins and angiotensin converting enzyme inhibitors," stated Cynthia Jackevicius, MD, a researcher at the Institute for Clinical Evaluative Sciences in Toronto and Western University of Health Sciences in Ponoma, Calif., and colleagues from the Canadian Cardiovascular Outcomes Research Team.

Many of these medications are brand name drugs and the authors suggested that older drugs may still be the best option, the authors found.

"Given the magnitude of growth of the expenditures involved, ensuring the prescribing of cost-effective medications is essential," the authors concluded.

In a related commentary, Robert Califf, MD, from Duke University Medical Center in Durham, N.C., wrote that the higher costs of CV medication prescribing might result in a health benefit that would be worth the increases in spending. He noted that accurate information, such as including prescribing information in EMRs, could provide rapid evidence about the best medications for patient conditions and be incorporated into practice.