1. Trends in utilization of services associated with introduction of drug coverage for Cholinesterase Inhibitors (ChEI) Malcolm Maclure, ScD, Professor Wendy Smith and Colin Dormuth, Assistant Professor Dept Anesthesiology, Pharmacology and Thereapeutics, UBC

2. Disclosures Dr. Maclure is a half-time employee of BC Ministry of Health: Co-Director of Research and Evidence Development in Pharmaceutical Services Division. Dr. Dormuth receives partial funding support from Pharmaceutical Services Division.

3. Relation among ADTI studies Utilization & Cost Study cohort – 76,094 new ADRD dx: Nov 1, 2002 to Oct 31, 2009 – Ever-users of ChEI in cohort: 14,327 (19%) Clinical Epidemiology cohort: Nov 2007-Sep 2011 – >18,000 patients approved for Special Authority Contacts: 2254 Triage for eligibility: 1124 Caregiver Appraisal Study: 1071 enrolled Seniors Medication Study: 198 indeterminate CLIMAT: ~100

4. Utilization Cohort Study Design BEFORE AFTER CONTROL BEFOREAFTER Policy began

5. Policy impact: Use of ChEIs up 13% Policy began

6. Coinciding drop in use of antipsychotics Policy began

7. No impact on use of MD services Policy began

8. No impact on rate of entry to Long- Term or Palliative Care Policy began

9. Probably no reduced mortality Policy began

10. No reduction in hospital admissions Policy began

11. Policy increased AD diagnosis rate Policy began

12. Drug use trends are greatly influenced by marketing Policy began

13. Drug use trends are greatly influenced by marketing Policy began

14. Fairly stable incidence rate of new users before policy Policy began

15. Incidence rate of ADRD drug initiation, by age group Policy began

16. Not zero Antipsychotic incidence rate was declining for other reasons Policy began

17. Antipsychotic incidence rate was declining for other reasons Policy began

18. Preliminary conclusions The Alzheimer’s Drug Therapy Initiative has not yet been found to be associated with an overall reduction in healthcare utilization Trend analysis, comparing the Policy Cohort with Historical Controls, is made more difficult by surges in marketing of new drugs Drug marketing and drug insurance policy changes seem to influence rate of diagnosis of Alzheimer’s Disease.