CMAJ: Restricting ARB use could have saved Canada $77M

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If Canada adopted a more restrictive policy on administering ARBs that did not negatively affect cardiovascular health, the country could have saved the healthcare system $77 million in 2006, according to a study published in the January issue of the Canadian Medical Association Journal.

“The use of angiotensin-receptor blockers increased by more than 4,000 percent in Canada from 1996 to 2006,” the authors wrote. However, use of these drugs has not been strongly supported by evidence, and these agents could be safely substituted by ACE inhibitors, the researchers noted.

Similarly, the costs of cardiovascular drugs in Canada increased by more than 200 percent between 1996 and 2006, according to the researchers. 

To understand the potential cost savings if ARB use had been restricted, Jason R. Guertin, MSc, of the Centre de recherche du Centre hospitalier de l’Université de Montréal in Montreal, and colleagues performed a cost-minimization analysis using IMS Health Canada data that outlined the costs and use associated with ARBs and ACE inhibitors throughout Canada between Jan.1, 2005, and Dec. 31, 2006.

All study data used 2006 Canadian dollars and the researchers used a decision-tree model to analyze two scenarios: status quo of no restriction on the use of ARBs across Canada and the economic outcomes of a policy that restricted the use of ARBs.

The researchers reported that the most frequent ACE inhibitors prescribed were ramipril and lisinopril and the most frequently distributed ARBs were valsartan and irbesartan.

“[I]n the case of ARBs, restricted access can result in substantial savings without leading to underuse or adverse clinical outcomes,” the authors wrote. The researchers said that in Sweden, a reimbursement restriction was put on ARBs in 2008 and ARB administration decreased by 24 percent, which lead to a 5 percent decrease in total drug expenditures.

Additionally, the researchers said that by switching from a thiazide diuretic plus either an ACE inhibitor or ARB to a single combination drug could save an estimated $45 million.

“Given a future of increasing economic uncertainty complicated by a demographic shift to an older population with a relatively shrinking tax base, measures are needed to deal with the rising healthcare costs,” the researchers wrote. “Policies can neither be draconian nor take a one-size-fits-all approach. Patient well being must always come first.”

The authors concluded that certain cost-sharing strategies such as co-payments or caps are less reliable because they shift the burden to patients and could lead to under use, which would increase adverse outcomes.