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Urban–rural differences in the uptake of new oral bisphosphonate formulations

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Abstract

Summary

We identified significantly slower uptake, and consistently lower proportions of new oral bisphosphonate formulations dispensed in rural regions compared to urban regions of Ontario. Further research examining regional differences in outcomes may provide insight as to whether urban–rural differences in prescribing translate into health disparities between regions.

Purpose

The aim of this study was to examine urban–rural differences in the uptake of new oral bisphosphonate formulations available on the Ontario drug formulary: alendronate + vitamin D3 (January 2007), monthly risedronate (June 2009), and risedronate delayed-release (February 2012).

Methods

We plotted the monthly proportion of new formulation claims of all claims with the same drug molecule, from their formulary listing date until March 2014. Results were stratified by major urban, nonmajor urban, and rural regions as defined by the Rurality Index of Ontario. We compared the rate of uptake over the first year of formulary availability using linear regression, and compared proportions dispensed between regions using chi-squared tests.

Results

We identified a regional gradient in uptake for alendronate + vitamin D3 and monthly risedronate; major urban regions had the fastest uptake, followed by nonmajor urban regions, and rural regions had the slowest uptake. Rural regions also had the slowest uptake of risedronate delayed-release; however, uptake in major urban and nonmajor urban regions were similar. Rural regions dispensed the lowest proportions for all new formulations 1 year after formulary availability: alendronate + vitamin D3 (32 % major urban, 23 % nonmajor urban, 12 % rural), monthly risedronate (26 % major urban, 21 % nonmajor urban, 16 % rural), and risedronate delayed-release (21 % major urban, 22 % nonmajor urban, 13 % rural). This pattern persisted throughout our study.

Conclusion

We identified significantly slower uptake and lower proportions of new formulations dispensed in rural regions compared to urban regions. Further research examining regional differences in outcomes may demonstrate whether urban–rural differences in prescribing translate into health disparities between regions.

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Acknowledgments

This research was supported by an Ontario Ministry of Research and Innovation Early Researcher Award held by Dr. Suzanne Cadarette. Dr. Cadarette was supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award (MSH-95364), and Racquel Jandoc received support from the CIHR Training Program in Bridging Scientific Domains for Drug Safety and Effectiveness, and a Leslie Dan Faculty of Pharmacy Clinical, Social, and Administrative Pharmacy Professor’s Award to support analyses. This study was completed as part of Racquel Jandoc’s MSc thesis and was presented at the Canadian Society for Epidemiology and Biostatistics Annual Conference in Mississauga, Ontario, Canada, June 2015, and the International Conference for Pharmacoepidemiology and Therapeutic Risk Management in Boston, MA, USA, August 2015. Authors thank Andrea M. Burden, PhD, University of Toronto, and Mina Tadrous, PharmD, PhD, University of Toronto, for insightful discussions, and IMS Brogan Inc. for use of their Drug Information Database .

Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. All analyses were completed at the Institute for Clinical Evaluative Sciences (ICES) University of Toronto satellite site, with support from the Leslie Dan Faculty of Pharmacy, University of Toronto. ICES is a nonprofit research corporation funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions herein are those of the authors and are independent from the funding sources. No endorsement by CIHR, ICES, or the MOHLTC should be inferred.

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Authors and Affiliations

  1. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada

    Racquel Jandoc, Muhammad Mamdani & Suzanne M. Cadarette

  2. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Muhammad Mamdani & Suzanne M. Cadarette

  3. Applied Health Research Center, La Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Muhammad Mamdani

  4. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Muhammad Mamdani

  5. Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada

    Linda E. Lévesque

Authors
  1. Racquel Jandoc
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  2. Muhammad Mamdani
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  3. Linda E. Lévesque
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  4. Suzanne M. Cadarette
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Correspondence to Racquel Jandoc.

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Appendix

Appendix

Fig. 5
figure 5

Proportion of brand and generic alendronate + vitamin D3 claims of total alendronate claims dispensed in Ontario by month (January 2007–March 2014), stratified by region

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Fig. 6
figure 6

Proportion of brand and generic monthly risedronate claims of total risedronate claims dispensed in Ontario by month (June 2009–March 2014), stratified by region

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Jandoc, R., Mamdani, M., Lévesque, L.E. et al. Urban–rural differences in the uptake of new oral bisphosphonate formulations. Arch Osteoporos 11, 11 (2016). https://doi.org/10.1007/s11657-016-0261-8

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