ONTARIO PATTERNS OF ANTIRETROVIRAL UTILIZATION: 1997 TO 2000

A Rachlis¹, C Jones², R Remis³, C Major^4
1Sunnybrook and Women’s College Health Sciences Centre, University of Toronto; ²Ontario HIV Treatment Network; ³University of Toronto; ⁴HIV Laboratory, Ontario Ministry of Health and Long-Term Care

Objectives: Until October, 2001, antiretroviral therapies (ARTs) for HIV/AIDS available through the Ontario Drug Benefit (ODB) and Trillium drug programs were restricted as Limited Use products, with their reimbursement conditional on compliance with certain clinical and administrative criteria. Prescribers and people living with HIV/AIDS (PHAs) long argued that such restrictions placed an unnecessary administrative burden on the delivery of care for PHAs. To address this, in February, 2001, the Ontario HIV Treatment Network prompted a review of the ODB Formulary status of antiretrovirals by Ontario’s Drug Quality and Therapeutics Committee by proposing that ART utilization in Ontario was aligned with clinical practice guidelines, despite Limited Use criteria that were themselves inconsistent with current evidence.
Methods: To demonstrate this, a review of administrative data contained in the Viral Load Database administered by Ontario’s HIV Laboratory was conducted. Combinations of ARTs reported on Viral Load Test Requisition forms were analyzed to determine the extent to which they conformed to recommendations from extant clinical practice guidelines for highly-active antiretroviral therapy at initiation of therapy, and when changes in therapy are made.
Results: This analysis demonstrated that up to 67% of reported combinations of ARTs at initiation were consistent with guidelines’ recommendations over the period January 1, 1997 to June 30, 2000. Moreover, no reported combinations could be characterized as “not recommended.” This evidence supported an argument for eliminating Limited Use restrictions that was accepted by DQTC in May, 2001 and implemented October, 2001, affecting 13 drugs.
Conclusions: This analysis strongly suggests that, for the period in question, Ontario prescribers were adequately informed about appropriate ART use. Overall, this initiative provides an important new model for third-party involvement in reimbursement reviews of certain classes of medications. It also confirms that drug utilization reviews based on administrative data are an effective tool in shaping reimbursement arrangements after market entry.