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The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men
BACKGROUND: Despite a lack of data describing the long-term efficacy and safety of testosterone replacement therapy (TRT), prescribing of testosterone to older men has increased with the availability of topical formulations. The magnitude of this increase and the impact of formulary restrictions on...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100730/ https://www.ncbi.nlm.nih.gov/pubmed/25029014 http://dx.doi.org/10.1371/journal.pone.0098003 |
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author | Piszczek, Jolanta Mamdani, Muhammad Antoniou, Tony Juurlink, David N. Gomes, Tara |
author_facet | Piszczek, Jolanta Mamdani, Muhammad Antoniou, Tony Juurlink, David N. Gomes, Tara |
author_sort | Piszczek, Jolanta |
collection | PubMed |
description | BACKGROUND: Despite a lack of data describing the long-term efficacy and safety of testosterone replacement therapy (TRT), prescribing of testosterone to older men has increased with the availability of topical formulations. The magnitude of this increase and the impact of formulary restrictions on testosterone prescribing are poorly characterized. METHODS: We conducted a time series analysis using the linked health administrative records of men aged 66 years or older in Ontario, Canada between January 1, 1997 and March 31, 2012. We used interventional autoregressive integrated moving average models to examine the impact of a restrictive drug reimbursement policy on testosterone prescribing and examined the demographic profile of men initiating testosterone in the final 2 years of the study period. RESULTS: A total of 28,477 men were dispensed testosterone over the study period. Overall testosterone prescribing declined 27.9% in the 6 months following the implementation of the restriction policy (9.5 to 6.9 men per 1000 eligible; p<0.01). However, the overall decrease was temporary and testosterone use exceeded pre-policy levels by the end of the study period (11.0 men per 1000 eligible), largely driven by prescriptions for topical testosterone (4.8 men per 1000 eligible). Only 6.3% of men who initiated testosterone had a documented diagnosis of hypogonadism, the main criteria for TRT reimbursement according to the new policy. CONCLUSION: Government-imposed restrictions did not influence long-term prescribing of testosterone to older men. By 2012, approximately 1 in every 90 men aged 66 or older was being treated with TRT, most with topical formulations. |
format | Online Article Text |
id | pubmed-4100730 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-41007302014-07-18 The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men Piszczek, Jolanta Mamdani, Muhammad Antoniou, Tony Juurlink, David N. Gomes, Tara PLoS One Research Article BACKGROUND: Despite a lack of data describing the long-term efficacy and safety of testosterone replacement therapy (TRT), prescribing of testosterone to older men has increased with the availability of topical formulations. The magnitude of this increase and the impact of formulary restrictions on testosterone prescribing are poorly characterized. METHODS: We conducted a time series analysis using the linked health administrative records of men aged 66 years or older in Ontario, Canada between January 1, 1997 and March 31, 2012. We used interventional autoregressive integrated moving average models to examine the impact of a restrictive drug reimbursement policy on testosterone prescribing and examined the demographic profile of men initiating testosterone in the final 2 years of the study period. RESULTS: A total of 28,477 men were dispensed testosterone over the study period. Overall testosterone prescribing declined 27.9% in the 6 months following the implementation of the restriction policy (9.5 to 6.9 men per 1000 eligible; p<0.01). However, the overall decrease was temporary and testosterone use exceeded pre-policy levels by the end of the study period (11.0 men per 1000 eligible), largely driven by prescriptions for topical testosterone (4.8 men per 1000 eligible). Only 6.3% of men who initiated testosterone had a documented diagnosis of hypogonadism, the main criteria for TRT reimbursement according to the new policy. CONCLUSION: Government-imposed restrictions did not influence long-term prescribing of testosterone to older men. By 2012, approximately 1 in every 90 men aged 66 or older was being treated with TRT, most with topical formulations. Public Library of Science 2014-07-16 /pmc/articles/PMC4100730/ /pubmed/25029014 http://dx.doi.org/10.1371/journal.pone.0098003 Text en © 2014 Piszczek et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Piszczek, Jolanta Mamdani, Muhammad Antoniou, Tony Juurlink, David N. Gomes, Tara The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men |
title | The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men |
title_full | The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men |
title_fullStr | The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men |
title_full_unstemmed | The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men |
title_short | The Impact of Drug Reimbursement Policy on Rates of Testosterone Replacement Therapy among Older Men |
title_sort | impact of drug reimbursement policy on rates of testosterone replacement therapy among older men |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100730/ https://www.ncbi.nlm.nih.gov/pubmed/25029014 http://dx.doi.org/10.1371/journal.pone.0098003 |
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