Trends in Health Care Utilization in British Columbia Following Public Coverage for Tiotropium

Objectives: To examine the use and cost of health-care services in British Columbia, Canada, before and after public drug coverage for tiotropium bromide. Methods: A time series analysis was performed using data from British Columbia's centralized administrative health-care databases. Linear regression on data from a stable 3-year prepolicy period was used to predict future use of inhaled anticholinergic (IAC) medications, visits to physicians, emergency hospitalizations, and costs. For each use measure, we estimated the policy effect as the difference between observed use in the postpolicy period and predicted use obtained from the prepolicy period. Results: In total, over the 2.5-year period after public coverage, tiotropium use increased by 24.4% more than predicted (95% confidence interval [CI] 23.9%-24.8%). Visits to physicians were unchanged, but there were between 596 and 948 more emergency admissions for chronic obstructive pulmonary disease, and between 582 and 1940 more hospital admissions of any kind than were predicted from prepolicy data. Total cost of inhaled IAC medications increased slightly more than predicted, by between an additional CDN$1.30 million and CDN$1.71 million, but total out-of-pocket spending by patients on IAC medications was reduced by between CDN$2.83 million and CDN$3.11 million because of public coverage. Hospital costs were between CDN$3.88 million and CDN$12.93 million greater than anticipated based on prepolicy data. Conclusions: Public drug plan coverage for tiotropium in British Columbia reduced out-of-pocket costs for patients and their private insurers. Before versus after time series analysis did not show a reduction in hospitalizations or physician visits, or costs associated with those services.