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Canadian Journal of Gastroenterology and Hepatology
Volume 2017, Article ID 7365937, 8 pages
Research Article

Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease

1Department of Medicine, University of Toronto, Toronto, ON, Canada
2Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
4Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canada
5Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada

Correspondence should be addressed to Geoffrey C. Nguyen; ac.otnorotu@neyugn.ffoeg

Received 21 September 2016; Accepted 13 December 2016; Published 23 January 2017

Academic Editor: Mark Borgaonkar

Copyright © 2017 Amir Rumman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Antitumor necrosis factor (anti-TNF) therapy is a highly effective but costly treatment for inflammatory bowel disease (IBD). Methods. We conducted a retrospective cohort study of IBD patients who were prescribed anti-TNF therapy (2007–2014) in Ontario. We assessed if the insurance type was a predictor of timely access to anti-TNF therapy and nonroutine health utilization (emergency department visits and hospitalizations). Results. There were 268 patients with IBD who were prescribed anti-TNF therapy. Public drug coverage was associated with longer median wait times to first dose than private one (56 versus 35 days, ). After adjusting for confounders, publicly insured patients were less likely to receive timely access to anti-TNF therapy compared with those privately insured (adjusted hazard ratio, 0.66; 95% CI: 0.45–0.95). After adjustment for demographic and clinical characteristics, publicly funded subjects were more than 2-fold more likely to require hospitalization (incidence rate ratio [IRR], 2.30; 95% CI: 1.19–4.43) and ED visits (IRR 2.42; 95% CI: 1.44–4.08) related to IBD. Conclusions. IBD patients in Ontario with public drug coverage experienced greater delays in access to anti-TNF therapy than privately insured patients and have a higher rate of hospitalizations and ED visits related to IBD.