The Financial Burden of Prescription Medications in Chronic Obstructive Pulmonary Disease

Abstract RATIONALE: Medication costs are an important component of burden in many chronic conditions, and in many health jurisdictions, including in Canada, patients are at least partially responsible for covering their costs. We examined the excess medication costs, and the share of out-of-pocket costs, in individuals with chronic obstructive pulmonary disease (COPD). METHODS: Using administrative health databases of British Columbia, Canada, from 2001 to2020, we created a retrospective cohort of physician-diagnosed COPD patients ≥45 years of age.We constructed a comparison cohort from the general population, matching on key demographic and socioeconomic variables such as sex, year of birth, health service region, and neighbourhood income. Direct medical costs were assessed by analyzing detailed billing records from thePharmaNET medication dispensation dataset. Using generalized linear models combined with generalized estimating equations, we estimated the excess direct medication costs as the difference in all-cause medication costs between the COPD and non-COPD cohorts. These excess costs were calculated by comparing the overall medical expenses between individuals with COPD and those in the control cohort. Costs were reported in 2020 Canadian dollars ($). RESULTS: The final sample consisted of 207,502 COPD and 403,941 non-COPD individuals, with a mean baseline age of 68.7 for COPD, of whom 52.4% were male. The estimated average excess medication costs amounted to $1336 per patient-year (PY) [95% confidence interval (CI):$1,321-$1,352], with out-of-pocket expenses contributing $528/PY (95% CI: $521-$535). From2001 to 2020, the Average Annual Percentage Change (AAPC) for out-of-pocket costs was 10%, significantly higher than the overall medication cost increase (AAPC=6%). In both males and females, younger adults (aged 45-64 years) bore a higher financial burden compared to older adults (>=65 years). A similar trend was observed in males, with younger men incurring $485versus $473 for older men. Strikingly, out-of-pocket COPD-related medication costs represented50% of the total COPD-related medication cost. CONCLUSION: COPD represents a major financial burden for healthcare payers and individuals aged 45 and older in Canada. This study reveals that while more than half of the prescription drug costs were covered by traditional plans, patients were still responsible for 40%of out-of-pocket expenses. These findings emphasize the growing financial strain faced by patients managing COPD, underscoring the escalating personal costs associated with the condition.

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