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Randomized Controlled Trial
. 2023 May 5;4(5):e231127.
doi: 10.1001/jamahealthforum.2023.1127.

Effect of Free Medicine Distribution on Health Care Costs in Canada Over 3 Years: A Secondary Analysis of the CLEAN Meds Randomized Clinical Trial

Nav Persaud  1   2   3   4 , Michael Bedard  5 , Andrew Boozary  6 , Richard H Glazier  1   2   3   4   7   8 , Tara Gomes  1   2   9   10 , Stephen W Hwang  2   4   11 , Peter Jüni  4   11 , Michael R Law  12 , Muhammad Mamdani  2   9   11   13   14 , Braden Manns  15   16   17   18 , Danielle Martin  1   19 , Steven G Morgan  20 , Paul Oh  11   21 , Andrew D Pinto  1   2   7 , Baiju R Shah  4   8   11 , Frank Sullivan  22   23 , Norman Umali  2 , Kevin E Thorpe  7   10 , Karen Tu  1   4   22 , Fangyun Wu  8 , Andreas Laupacis  2   4   11 ; CLEAN Meds study team
Collaborators, Affiliations
Randomized Controlled Trial

Effect of Free Medicine Distribution on Health Care Costs in Canada Over 3 Years: A Secondary Analysis of the CLEAN Meds Randomized Clinical Trial

Nav Persaud et al. JAMA Health Forum. .

Abstract

Importance: Few interventions are proven to reduce total health care costs, and addressing cost-related nonadherence has the potential to do so.

Objective: To determine the effect of eliminating out-of-pocket medication fees on total health care costs.

Design, setting, and participants: This secondary analysis of a multicenter randomized clinical trial using a prespecified outcome took place across 9 primary care sites in Ontario, Canada (6 in Toronto and 3 in rural areas), where health care services are generally publicly funded. Adult patients (≥18 years old) reporting cost-related nonadherence to medicines in the past 12 months were recruited between June 1, 2016, and April 28, 2017, and followed up until April 28, 2020. Data analysis was completed in 2021.

Interventions: Access to a comprehensive list of 128 medicines commonly prescribed in ambulatory care with no out-of-pocket costs for 3 years vs usual medicine access.

Main outcome and measures: Total publicly funded health care costs over 3 years, including costs of hospitalizations. Health care costs were determined using administrative data from Ontario's single-payer health care system, and all costs are reported in Canadian dollars with adjustments for inflation.

Results: A total of 747 participants from 9 primary care sites were included in the analysis (mean [SD] age, 51 [14] years; 421 [56.4%] female). Free medicine distribution was associated with a lower median total health care spending over 3 years of $1641 (95% CI, $454-$2792; P = .006). Mean total spending was $4465 (95% CI, -$944 to $9874) lower over the 3-year period.

Conclusions and relevance: In this secondary analysis of a randomized clinical trial, eliminating out-of-pocket medication expenses for patients with cost-related nonadherence in primary care was associated with lower health care spending over 3 years. These findings suggest that eliminating out-of-pocket medication costs for patients could reduce overall costs of health care.

Trial registration: ClinicalTrials.gov Identifier: NCT02744963.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Persaud reported grants from the Canadian Institutes of Health Research, Ontario SPOR Support Unit, and St Michael’s Hospital Foundation during the conduct of the study. Dr Gomes reported grants from the Ontario Ministry of Health outside the submitted work. Dr Law reported personal fees from Health Canada and the Federation of Post-Secondary Educators outside the submitted work. Dr Pinto reported holding a Canadian Institutes of Health Research Applied Public Health Chair and serving as the associate director for clinical research at the University of Toronto Practice-Based Research Network. Dr Shah reported grants from the University of Toronto and holding the Novo Nordisk Research Chair in Equitable Care of Diabetes during the conduct of the study. Ms Wu reported grants from the Canadian Institutes of Health Research, Ontario SPOR Support Unit, and St Michael’s Hospital Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Flow Diagram of Participants
Figure 2.
Figure 2.. Number of Participants in Each Cost Category Measured Over 3 Years
All costs are reported in Canadian dollars with adjustments for inflation.
See this image and copyright information in PMC

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