(C-069) Comparison of Expenditure and Utilization of Top 25 High-Cost Drugs Across Canada and Comparable Countries

Background: Drug spending has risen in proportion with overall healthcare expenditures in Canada, estimated at $344 billion in total for 2023, the largest driver of this increase was wider utilization of high-cost drugs. Exploring and leveraging international market data stands to provide invaluable information to formulary decision-makers whose reimbursement decisions hinge on the ability to accurately forecast drug product uptake.

Objectives: To assess top-25 high-cost drug expenditure across the globe.

Methods: We conducted a repeated cross-sectional study of top-25 high cost drug purchases across Australia, Belgium, Canada, France, Germany, Italy, Japan, Netherlands, New Zealand, Norway, Spain, Sweden, the UK, and the US between the fourth quarter of 2022 and the third quarter of 2023. We used IQVIA’s Multinational Integrated Data Analysis (MIDAS) database to obtain country-level purchasing data. For each included country, we measured population-adjusted expenditure and utilization on the top-25 high cost drugs as a proportion of overall drug spending and compared high-cost drug classes between Canada and across the remaining countries. We estimated drug utilization based on sales volume.

Results: Among 14 comparable countries, the proportion of drug expenditure that was allocated to the top-25 high cost drugs averaged 28% but made up only 2.6% of total units sold on average. Canada ranked 6th regarding spending and in the bottom 5 on proportion of units sold on top-25 high cost drugs. The countries with the highest expenditure on the top-25 drugs were the US (38.4%), New Zealand (37.3%), Belgium (32.3%), Netherlands (30.7%) and Norway (29.1%) respectively. Despite high proportion of total expenditure, the top-25 high expenditure drugs allocated only 1.8% - 5.4% of total drug volume amongst these countries. Top-25 high cost drug expenditure was distributed across 29 different drug classes. The most commonly occurring drug classes observed across high-cost drugs were drugs used in diabetes and immunosuppressants.

Conclusions: Top-25 high cost drug expenditure varies across countries, with approximately one third of total drug expenditure allocated to the top-25 high cost drugs and less than 3% of total drug volume on average. High expenditure and low drug volume of the top-25 high cost drugs suggests the proportion of spending is driven by utilization of expensive treatments distributed across a range of drug classes. These findings highlight varying healthcare priorities and pharmaceutical market dynamics across these countries and underscores the complexity and variability in drug spending patterns. Important lesson can be learned from international jurisdiction and further research is warranted in understanding the market shifts across the globe.