| الوصف: |
The Canadian drug insurance consists of a patchwork of public and private plans. This system has been the subject of criticism for decades. In June 2019, the Advisory Council on the Implementation of National Pharmacare recommended the implementation of a national public and universal single-payer plan for prescription drug coverage in Canada. The cost of prescribed biologic agents is disproportionately high compared to the number of corresponding claims. The reimbursement criteria for biological agents in psoriasis are demanding: they are based on validated severity scores and failure to previous therapies. Several studies in autoimmune diseases observed an association between patients' insurance and access to biologic agents, to the detriment of individuals publicly insured. We aimed to compare: 1) psoriasis severity scores at time of biologic prescription in public versus private groups; 2) severity scores at follow-up; 3) treatment response; 4) delay between prescription and first dose of biotherapy. This retrospective cohort study included psoriasis patients with dermatologist-prescribed biologics from 09/01/2015-08/31/2019 in Quebec City, Canada. Data were collected from medical records. Statistical analyses included univariate and multivariate analyses which were conducted using SAS® Studio 3.8. Public (n=78) and private (n=93) patients were not different in outcomes. Patients' characteristics differed between groups. Public patients were older (p<.0001), more socioeconomically deprived (p=.03), and more likely to benefit from compassion prescription (p<.0001) compared to privately insured. Prescribers of biologics can be reassured as our results did not reveal inequality in access or care. The high prevalence of compassionate programs (42% versus 14%) and psoriasis in the face/genitalia/palmoplantar areas (85.4%) observed in the public insurance group may mask differences in PASI response between groups. ; L'assurance médicaments au Canada est formée d'une mosaïque de régimes publics et privés. Ce ... |