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The British Columbia Rx atlas, 2nd edition Morgan, Steve; Cunningham, Colleen; Hanley, Gillian; Mooney, Dawn Sep 30, 2009

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Steve Morgan, PhDColleen Cunningham, MAGillian Hanley, MADawn Mooney, BAThe British ColumbiaRx Atlas2nd EditionSeptember 2009Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson16125-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%311113Logarithmic scaleIndicates one LHAThe British Columbia Rx Atlas, 2nd Edition (The British Columbia Prescription Drug Atlas) was produced by:Centre for Health Services and Policy ResearchUniversity of British Columbia#201 – 2206 East Mall (LPC) Vancouver, BC   V6T 1Z3 Phone: 604-822-4969 Email: enquire@chspr.ubc.caYou can download this publication from our website, at www.chspr.ubc.ca        This work is licensed under a Creative Commons Attribution-Noncommercial          2.5 Canada license.How to cite this report:  Morgan, S., C. Cunningham, G. Hanley, and D. Mooney. (2009). The British Columbia Rx Atlas, 2nd Edition. Vancouver, Centre for Health Services and Policy Research, University of British Columbia.Library and Archives Canada Cataloguing in Publication The British Columbia Rx atlas / Steve Morgan ... [et al.]. -- 2nd ed.ISBN 978-1-897085-19-6 1. Solid dosage forms--Prices--British Columbia.  2. Drugs--Prices-BritishColumbia.  3. Drug utilization--British Columbia.  4. Drugs--Prescribing--British Columbia.  I. Morgan, Steve  II. University of British Columbia. Centre for Health Services and Policy Research RA410.55.C35B75 2009                  338.4’3615109711                   C2009-904999-6 U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1Contents 2 About CHSPR 3 Acknowledgments 4 Introduction 6 Methods 12 How to read the maps 16 Importance of “fair comparisons” 18 Key findings Chapters of analysis by category 25 1 All prescription drugs on the market  Cardiovascular drugs 37 2.1 Antihypertensives 49 2.2 Statins 61 2.3 Antithrombotics  Neurological drugs 73 3.1 Antidepressants 85 3.2 Antipsychotics 97 3.3 Gabapentin, pregabalin, topiramate 109 3.4 Benzodiazepines and related drugs 121 3.5 Cholinesterase inhibitors 133 3.6 Drugs for Parkinson’s disease 145 3.7 Psychostimulants 157 4 Acid-reducing drugs  Analgesics 169 5.1 Opioid drugs181 5.2 Nonsteroidal anti-inflammatory drugs 193 6 Inhaled drugs for respiratory conditions    Diabetes drugs205 7.1 Oral drugs217 7.2 Insulins229 8 Oral antibiotics241 9 Hormonal contraceptives253 10 Drugs for erectile dysfunction265 11 Bisphosphonates Appendices278 A Intensity of drug use: Polypharmacy280 B Post-AMI drug use282 C Long-term benzodiazepine use284 D Chronic proton pump inhibitor use286 E Population age287 F Health status288 G Average income289 H University education290 I Asian immigrationt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n2About CHSPRThe Centre for Health Services and Policy Research (CHSPR) is an independent research centre based at the University of British Columbia. Our mission is to stimulate scientific inquiry into ways in which health care services can best be organized, funded, and delivered to promote the health of populations.CHSPR aims to contribute to the health of populations by ensuring that our research is relevant to contemporary health policy concerns and by working closely with decision-makers to translate research findings into policy options. Our researchers are active participants in many policy-making forums and provide government and non-government organizations in British Columbia, Canada, and abroad with advice and assistance.CHSPR receives funding from the British Columbia Ministry of Health to support research with a direct role in informing policy. Our researchers are also funded by competitive external grants from provincial, national, and international funding agencies. For more information about CHSPR, please visit www.chspr.ubc.ca.U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h3AcknowledgmentsThis project was made possible through the financial support of the British Columbia Ministry of Health Services and the Canadian Institutes of Health Research (CIHR). Although we have shared results of this atlas with staff of the Pharmaceutical Services Division, we were not directed in any way by the BC Ministry of Health Services or by the CIHR.De-identified data for this project were extracted from the Population Data BC databases and the BC PharmaNet database with the permission of the BC Ministry of Health Services and the BC College of Pharmacists. We greatly appreciate their dedication to making data available for research of value to the public, professionals, and policy makers.Many colleagues contributed to the work presented in this atlas. Lixiang Yan provided invaluable assis-tance by converting tens of millions of claim-level data records into research variables needed by our project team. Daniel Martin spent tireless hours preparing most of the maps and illustrations found throughout the atlas. Natasha de Sousa assisted with the coordination of the project in its early stages.We are grateful to Drs. Colette Raymond, Charlyn Black, James Wright, and Barbara Mintzes for helping us to organize and describe drug categories in ways that can be meaningfully interpreted. In addition to these colleagues, Drs. Therese Stukel, Paul Grootendorst, and Colin Dormuth provided comments and suggestions regarding methodology and presentation of the data. Finally, editor Merrie-Ellen Wilcox helped make the atlas as clear and accessible as possible.We take sole responsibility for all results and conclusions in this atlas; no endorsement by supporting organizations and associates is intended or should be inferred.Steve Morgan, PhDColleen Cunningham, MAGillian Hanley, MADawn Mooney, BAt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n4What you will find in The British Columbia Rx Atlas, 2nd EditionPrescription drugsOver the past century, medical advances have made prescription drugs a central component of modern health care systems. Prescription drugs are used to treat many medical conditions, to reduce pain and discomfort associated with illness or injury, and to facilitate the preparation for, conduct of, and recovery from surgical procedures.It therefore should not be surprising that pre-scription drugs are a major component of health system spending. As of 2008, Canadians spent over $25.1-billion on prescription drugs used outside of hospitals and about $1.5 billion more on medicines used within hospitals (CIHI 2009; CIHI 2006). This far exceeds the $22.7 billion spent on all services provided by medical doctors in Canada in 2008. Because of the potency and cost of pharmaceuticals, information about prescription drug utilization and spending is critically important for overall health care quality and sustainability.Ideally, all patients with the need for treatment would be able to access appropriate and affordable prescrip-tion drugs regardless of factors not related to their need. There would be minimal overuse, underuse, or misuse; and evidence of such would, ideally, be monitored regularly so that corrective actions could be taken when needed.Regional variations in health careSeveral studies have shown that medical and surgical practices vary across regions (such as local health areas of Canadian provinces or health service areas of the United States) by more than would be expected on the basis of regional differences in the health needs of patients.Evidence also suggests that regional variations in medical and surgical practices can be costly in terms of health outcomes and financial expense (Fisher et al. 2003a, 2003b).Although prescription drugs are among the most important components of modern health care, relatively little is known about regional variations in their use and cost.Studies have shown that prescription drug spending varies across large jurisdictions (as The Canadian Rx Atlas has shown for Canadian provinces). But there are few studies of small-area variations in prescription drug spending and use.To our knowledge, no study has measured the extent to which regional variations in prescription drug spending and use are driven by regional differences in health needs.The British Columbia Rx AtlasThis 2nd edition of The British Columbia Rx Atlas details regional variations in prescription drug spending and use across 79 Local Health Areas (LHAs) in British Columbia (BC), Canada.To make “fair comparisons” across regions of the province, all analyses account for the age, sex, and health needs of residents within each LHA.This analysis is made possible by the availability of de-identified administrative datasets that describe the age, sex, health status, and medicine use of virtually all 4 million residents of BC. Together, these databases constitute one of the most comprehensive information resources of its kind in the world.We used advanced statistical techniques on the BC datasets, quantifying not only regional variations in spending but also the regional variations in factors that determine the extent of spending.IntroductionU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h5We computed regional variations in the following factors related to prescription drug use and cost:Prescription drug spending per capita• The number of users of treatment per 1,000 • residentsThe average number of days of treatment received • per user of therapy, and The average cost of treatment per day.• Contents of the atlasThe atlas provides detailed information about regional variations in the use of and spending on all prescrip-tion drugs combined, as well as regional variations in 20 top therapeutic categories (some of which are grouped by major treatment area, such as “cardiovas-cular” or “neurological” treatments).In addition to providing detailed analyses of regional variations in use and spending, the atlas provides information about the number of prescription drugs listed on the provincial formulary, the share of spending financed by the BC government, and the share of prescription drug users for whom the BC gov-ernment pays at least half of their prescription costs.We also provide information about the regional varia-tions in potentially inappropriate use of prescription drugs (such as long-term use of benzodiazepines).Information about characteristics of local populations that may (or may not) explain some of the findings in this atlas are included in the appendices. It is impor-tant to note, however, that all of our analyses adjust for the age, sex, and health status of individual residents.Information resourcesWe do not draw conclusions about policy or practices in this atlas. Instead, we hope that this 2nd edition of The British Columbia Rx Atlas will serve as a valuable guide for the policy makers, health care professionals, and health services researchers who are best posi-tioned to determine which areas are worthy of further investigation or potential policy intervention.To facilitate access to and use of the information provided, the entire atlas is available for download at www.chspr.ubc.ca. There you will also find download-able versions of data tables and “slide-ready” versions of most of the illustrations found in the atlas. ReferencesCIHI (2006). Drug Expenditure in Canada, 1985–2005. Ottawa, Canadian Institute for Health Information.CIHI (2009). Drug Expenditure in Canada, 1985–2008. Ottawa, Canadian Institute for Health Information.Fisher, E. S., D. E. Wennberg, et al. (2003a). “The implications of regional variations in Medicare spending. Part 1: The content, quality, and acces-sibility of care.” Ann Intern Med 138(4): 273–87.Fisher, E. S., D. E. Wennberg, et al. (2003b). “The implications of regional variations in Medicare spending. Part 2: Health outcomes and satisfaction with care.” Ann Intern Med 138(4): 288–98.t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n6FrameworkWe used advanced statistical methods and population-based administrative health care datasets to quantify the extent of regional variations in prescription drug spending and use across Local Health Areas (LHAs) of British Columbia (BC). We compared what was actually observed in each LHA in 2006 with predic-tions for the LHA based on provincial averages for the age, sex, and health status of its residents.We analyzed regional variations in the use of and spending on all prescription drugs combined, as well as regional variations in 20 top therapeutic categories (some of which are grouped by major treatment area, such as “cardiovascular” or “neurological” treatments). For each grouping of medicines studied, we quanti-fied variation in the following four measures for the calendar year 2006:Spending per capita•  —the total amount spent (by government, private insurers, and patients) on relevant prescription drugs per resident of a given regionUsers of treatment per 1,000 residents•  —the number of people who fill one or more prescrip-tions for relevant drugs per 1,000 residents of a given regionDays of treatment per user•  —the average number of days of relevant drug therapy received by residents who filled one or more prescriptions for relevant drugs in a given region Cost of treatment per day•  —the average cost per day of relevant prescription drug treatment received by residents of a given region.These four measures are related, insofar as the latter three factors directly influence spending per capita: changes in the rate of treatment use, average treatment duration, or average treatment cost will have direct impacts on spending per capita.Data sourcesWe used de-identified, linked administrative data from Population Data BC and BC PharmaNet.Our prescription drug data came from BC PharmaNet, a dataset containing records of every prescription dispensed from community pharmacies and long-term care facilities in BC. This excludes medicines used in acute care hospitals.Spending data reported here reflect total (private and public) expenditure on prescription drugs, including all markups and dispensing fees. For data quality purposes, we excluded records of purchases of medi-cines available for sale without a prescription (e.g., over-the-counter drugs).Our data on health care use came from Population Data BC. This included demographic information, such as age, sex, and LHA of residence, and informa-tion on all hospital discharges and all visits to fee-for-service physicians in 2006.CohortThe databases used to produce this atlas cover every resident of BC except select populations whose health care is under federal jurisdiction—that is, First Nations, veterans, and Royal Canadian Mounted Police (approximately 4% of the population).To ensure that our analyses described a full year of health care and pharmaceutical use, we excluded any resident who lived in BC for fewer than 275 days in 2006 (approximately 4% of the population). After exclusions, we were left with comprehensive data for 3.9 million (92%) of the 4.2 million individuals living in BC in 2006.MethodsU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h7RegionsLHAs are geographically contiguous regions used for the planning of health services delivery. We analyzed variations across 79 of the 89 LHAs in BC. We excluded four of the 89 LHAs because of small population size: Nisga’a, Telegraph Creek, Stikine, and Snow Country. We excluded six more LHAs because they had very high rates (>30%) of non-fee-for-service medical care provision: Fernie, Bella Coola, Central Coast, Vancou-ver Island West, Queen Charlotte, and Upper Skeena. This exclusion was necessary because our health status measures are based, in part, on administrative records of fee-for-service medical visits (see “Health status measures,” below).Therapeutic categoriesWe provide in-depth analyses of the use and cost of prescription drugs within 20 therapeutic categories chosen because they are commonly used and/or account for significant shares of spending. These are the same therapeutic categories analysed in The Canadian Rx Atlas (2008).We used the World Health Organization’s Anatomi-cal Therapeutic Chemical (ATC) drug classification system to construct therapeutic categories. The ATC system groups drug products based on the anatomic system on which they act, their therapeutic properties, and their chemical characteristics. Our therapeutic categories were based on the level of the ATC system that groups drugs together on the basis of therapeutic or pharmacological properties (e.g., the ATC value N06A is for “antidepressants”). We clustered ATC groupings if they generally had a common primary indication; for example, our “antihypertensives” category combines ATC groupings for diuretics, beta blockers, calcium channel blockers, ACE-inhibitors, and angiotensin II receptor blockers.Together, the 20 therapeutic categories selected for in-depth analysis represented 78% of all spending on prescription drugs in 2006.Health status measuresFor every individual in our research dataset, we con-structed measures of general and condition-specific health status using the Johns Hopkins University ACG Case-Mix System (Weiner et al. 1991).The ACG system produces health status measures based on diagnostic information from administrative health care data. We ran the ACG software (version 7.0) on diagnoses drawn from every record of medical and hospital service use for each person in our database. Each hospital discharge record in our dataset contained up to 25 ICD-10 diagnosis codes; and each record of a fee-for-service medical visit contained a single ICD-9 code indicating the primary reason for the visit.We used the ACG system’s Expanded Diagnostic Clusters (EDCs) to indicate the presence of specific clinical conditions. EDCs are groupings of diagnosis codes that describe the same underlying condition (e.g., hypertension).To gauge general health status, we used the Aggregated Diagnostic Groups (ADGs) from the ACG system. ADGs comprise 32 broad groupings of diagnosis codes that are similar in terms of disease severity and likelihood of persistence. We measured overall health status using the total number of ADGs for which an individual had diagnoses. This count of ADGs ranged from 0 to 32, with higher numbers indicating lower overall health status.t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n8Statistical modelsFor analyses of all types of prescription drug combined, and for each therapeutic category studied, we used a series of statistical models to describe varia-tions in our four measures of prescription drug use and cost.Spending per capitaOur first statistical model was of total (private and public) spending per capita in 2006. This analysis included every person in our database, regardless of whether they filled any prescriptions (from the given therapeutic category, where specified).To assist in the normalization of the data, we ran this statistical model on the natural logarithm of spending for each individual (plus $1 to avoid taking the logarithm of zero). We also used Heckman’s two-stage estimation procedure to correct for selection bias.The Heckman procedure involves calculating a specific term (the inverse Mills ratio) from a selection model describing the likelihood of having positive spending, and then adding this term to an ordinary least squares model describing spending per capita for those with positive pharmaceutical expenditures (Heckman 1979; Woodridge 2003).Our ordinary least squares model for this Heckman procedure included the following variables: age, sex, and overall health status (count of ADGs). Our selection model for this procedure used these variables plus indicators of specific health needs (matched to the therapeutic category, where specified).Results from this log-transformed model were pro-jected back to levels.Users of prescriptionsOur second statistical model was of the likelihood that an individual filled one or more prescriptions in 2006 (from within the therapeutic category, where specified). This analysis included every person in our database.We used logistic regression for this model, which included the following variables: age, sex, overall health status (count of ADGs), and indicators of specific health needs (matched to the therapeutic category, where specified).Days of treatment per userOur third statistical model was of the number of days of treatment purchased per user of one or more prescriptions in 2006 (from within the therapeutic category, where specified). This analysis included only those persons who filled at least one relevant prescrip-tion in 2006.We used ordinary least squares for this model, which included the following variables: age, sex, overall health status (count of ADGs), and indicators of specific health needs (matched to the therapeutic category, where specified).Cost of treatment per dayOur fourth statistical model was of the total (private and public) cost of treatment per day for individuals who filled one or more prescription in 2006 (from within the therapeutic category, where specified). This analysis included only those persons who filled at least one relevant prescription in 2006.We used ordinary least squares for this model, which included the following variables: age, sex, overall health status (count of ADGs), and indicators of specific health needs (matched to the therapeutic category, where specified).Methods (continued)U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h9In order to accurately compute the average cost per day of treatment, we weighted each patient-level observation in this model by the number of days of treatment the patient received. If we had not done so, computed average costs per day of treatment would be skewed by the fact that each patient’s average cost per day of treatment would receive the same weight regardless of how many (or how few) days of therapy the patient received.Measures of variationFor every individual in our research dataset, the databases provided us with four measures of prescrip-tion drug spending and use (e.g., spending, use, days, and cost) as actually observed in 2006. Our province-wide statistical models (described above) provided four estimates of these values based (in effect) on the provincial averages for persons of the given age, sex, and health status.Our measures of regional variation are based on comparing what was actually observed in 2006 for residents in a given LHA with what the province-wide statistical model predicts for the LHA residents. Throughout this atlas, we refer to this as a comparison of the actual value for the LHA and the levels predicted based on provincial averages for populations of the same age, sex, and health status.Testing significanceWe tested the statistical significance of differences between what was actually observed in an LHA and what was predicted by province-wide statistical models.To do this, we computed every statistical model described above 79 extra times. Each extra run included a different fixed-effect variable for testing the significance of differences between provincial averages and those of the specific LHA. This method compares each LHA to the provincial average (rather than to a “reference” LHA) while taking into account the age, sex, and health status of residents within the LHA.Throughout this atlas, we set measures of variation to zero when the statistical model indicated that differ-ences between the actual value for the LHA and the levels predicted based on provincial averages for popu-lations of the same age, sex, and health status were not statistically significant (at a 95% confidence level).As explained under Statistical Models, our province-wide statistical model for spending per capita is based on Heckman’s two-stage procedure to correct for selection bias. This method is unbiased but produces relatively large standard errors. As a result, some LHA-specific variations in spending per capita do not show up as statistically significant variations even though variations in the rate of use, days per user, or cost per day for the particular LHA do show up as statistically significant.Deviation scaleTo facilitate equivalent comparisons of LHAs with actual values of a given variable that are above levels predicted based on the provincial averages for popula-tions of the same age, sex, and health status to LHAs with actual values below predictions based on provin-cial averages, we report deviations using a logarithmic scale. Our scale is the logarithm of the ratio of the actual value for an LHA to the prediction for that LHA.A logarithmic scale is used because a basic ratio of 1.5 is not “as different” from 1.0 as a ratio of 0.5 is. The latter is a two-fold difference, and the former is not. Thus, our logarithm-based deviation scale reports these as –69% and +41%. This is better balanced in terms of drawing attention to relatively high versus relatively low values.t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 0Formulary listingsA provincial formulary lists medicines that a public drug plan will subsidize for eligible beneficiaries. A product may be listed on a formulary with or without restrictions. Restrictions may include a requirement that a patient try other treatments first, a requirement that the prescribing doctor be a specialist, or other conditions that must be met before a given patient receives a subsidy.To provide contextual information, we report how many drug types within each therapeutic category were listed on the formulary for BC PharmaCare as of December 2006. Our data for this originated from the Canadian Institute for Health Information and exclude coverage information from special, condi-tion-specific programs, such as cancer and HIV/AIDS (Morgan et al. 2009). Thus, the estimates here understate the true extent of drug coverage in BC.We defined drug types by active ingredients, and included all strengths and brands. We deemed a drug type to have “unrestricted coverage” if at least one version of it (e.g., a generic) received unrestricted coverage under BC PharmaCare. We deemed a drug type to have “restricted coverage” if at least one version of it was available for subsidy only under certain conditions and no version of it was available without restrictions. Methods (continued)ReferencesHeckman, J.J. (1979). “Selection Bias as a Specification Error.” Econometrica 47(1): 153-161.Morgan, S., C. Raymond et al. (2008). The Canadian Rx Atlas. 2nd Ed. Vancouver: Centre for Health Services and Policy Research.Morgan, S. G. Hanley, et al. (2009) “Breadth, Depth and Agreement among Provincial Formularies in Canada.” Healthcare Policy. 4(4): 162-184Weiner, J.P., Starfield, B.H. et al. (1991). “Development and Application of a Population-Oriented Measure of Ambulatory Care Case-Mix.” Medical Care. 29(5): 452-472.Woodridge, J.M. (2003). Introductory Econometrics: A Modern Approach. 2nd Ed. Mason: Thomson South-Western.U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 1t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 2ALBERTAALASKAY U K O NW A S H I N G T O N878194605957565154538892505280 552883 492725262930241819461035711121314152322207821317716177675424346697062 616364656667687147728584 4833343532921Part ofVancouverCoastalNorthernInteriorVancouver         IslandVancouverCoastalFraserHow to read the mapsBritish Columbia’s health regionsBritish Columbia (BC) is divided into 89 Local Health Areas (LHAs), each of which belongs to one of five health authorities that are responsible for regional figure a» Map of BC’s regional health authorities and their constituent local health areas (LHA)health service planning and management. In Figure A, the health authorities are indicated by colour and name and LHAs are indicated by number.U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 3Using cartograms to depict population sizeA majority of BC’s population resides in the Vancouver and Victoria metropolitan areas, which are relatively small geographic areas in the southwest corner of the province. To ensure that areas with significant popula-tion can be “seen” in this report, we map patterns of prescription drug use onto a population cartogram of LHAs (Figure B).Instead of showing LHAs by land area and location, the cartogram shows them sized by their population. 51 Snow Country87 Stikine94 Telegraph Creek53 Upper Skeena56 Nechako57Prince George28 Quesnel   27Cariboo–Chilcotin25100 MileHouse20SalmonArm19 Revelstoke78 Enderby22Vernon18 Golden   9Castlegar11Trail12 Grand Forks13 Kettle Valley14 South Okanagan16 Keremeos33Chilliwack32Hope76 Agassiz–Harrison75Mission42MapleRidge38Richmond166 Vancouver South163VancouverNortheast162VancouverDowntown Eastside44NorthVancouver48HoweSound47PowellRiver85IslandNorth72CampbellRiver71Courtenay   69Qualicum  70Alberni68Nanaimo64GulfIslands63Saanich61GreaterVictoria65Cowichan62Sooke67 Ladysmith66 LakeCowichan84IslandWest46SunshineCoast 45 West   Van.–Bowen I.161VancouverCityCentre165VancouverMidtown164VancouverWestside37Delta201Surrey41Burnaby202       South Surrey–White Rock43Coquitlam40 NewWestminster34Abbotsford35Langley     15Penticton17 Princeton5 Creston2 Cranbrook1Fernie4 Windermere10ArrowLakes6KootenayLake23CentralOkanagan21Armstrong29Lillooet30SouthCariboo 31 Merritt77 Summerland24Kamloops26 NorthThompson81 Fort Nelson60 PeaceRiver North59 PeaceRiver South55 Burns Lake49 Bella Coola83 Central Coast54 Smithers   88Terrace80Kitimat50QueenCharlotte52PrinceRupert92 Nisga’a3 Kimberley7Nelsonfigure B» Population cartogram of BC’s local health areas (LHA)LHAs have been resized torepresent their population.1,000 peopleThe general shapes and locations of LHAs are retained, but regions with large population are much more prominent.Densely-populated urban and suburban health authorities—Vancouver Coastal (blue), Fraser (purple), and Vancouver Island (green)—stand out in the cartogram. More rural health authorities—Interior (yellow) and Northern (red)—are smaller in the cartogram, although their larger population centres remain prominent.t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 4How to read the maps (continued)t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n2IntroductionU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h3figure 4e» Users of treatment per 1,000 population in BC, by age group and primary source of fi nance, 2006Overall spending and useBritish Columbians spent $107-million, or $27.17 per capita, on acid reducing drugs during 2006. In terms of spending per capita, this was the 4th largest therapeu-tic category studied.Approximately 80 out of every 1,000 BC residents fi lled a prescription for an acid reducing drug in 2006. On average, these users received 185 days of treatment in 2006, indicating that many users do not take these medicines persistently.Leading drugs in classProton pump inhibitors accounted for virtually all spending on acid reducing drugs in BC during 2006.Provincial formulary coverageBC PharmaCare provided some level of coverage for all 9 types of acid reducing drug sold in Canada during 2006.Spending and use by ageDuring 2006, the use of and spending on acid reducing drugs in BC increased relatively steadily across all age groups of the population. More than 1 person in 8 over age 30 fi lled at least one prescription for an acid reducing drug in 2006, and more than 1 in 5 people over 70 years of age did so.Average spending per person by age group peaked at $96.28 for the cohort aged 80+. Because of their relative population size, however, the age groups 50–59, 60–69, and 70–79 all accounted for a greater share of total spending in this category. Notably, all three of those age groups accounted for 21% of total spending.With the exception of costs for persons over age 70, most spending on drugs in this class came from privately sources of fi nance.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$100$75$50$250-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population24018012060$0.7770% private;30% public82% private;18% public86% private;14% public$1.40$4.17$10.30$21.65$38.62$59.52$88.17$96.2841%59%46%54%68%32%79%21%79%21%80%20%75% private;25% publicPrivate spendingPublic spending712274774110161223 22540%60%47%53%70%30%83%17%84%16%86%14%86%14%76% private;24% publicUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyfigure 4d» Spending per capita in BC, by age group and source of fi nance, 2006figure 4C» Percentage of drug types within category that are covered by BC PharmaCarefigure 4B» Percentage of spending within category by specifi c drug typesfigure 4a» Spending within category relative to total spending on all prescription drugsOthers 10%Lansoprazole 10%Omeprazole 14%Esomeprazole 16%Pantoprazole 17%Rabeprazole 33%Total drug spendingper capitaSpending per capita on acid reducing drugs$27 $410OthersLansoprazoleOmeprazoleEsomeprazole PantoprazoleRabeprazole10%10%14%16% 17%33%Unrestricted coverageListing status as of December 2006Restricted coverage56% 44%Common goal of therapyTreat and prevent the risk of ulcers and • damage to esophagus due to acid refl uxExamples of indicated conditionsAcid refl ux• Peptic ulcer• Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$100$75$50$250-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population24018012060$0.7770% private;30% public82% private;18% public86% private;14% public$1.40$4.17$10.30$21.65$38.62$59.52$88.17$96.2841%59%46%54%68%32%79%21%79%21%80%20%75% private;25% publicPrivate spendingPublic spending712274774110161223 22540%60%47%53%70%30%83%17%84%16%86%14%86%14%76% private;24% publicUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyOthers 10%Lansoprazole 10%Omeprazole 14%Esomeprazole 16%Pantoprazole 17%Rabeprazole 33%Total drug spendingper capitaSpending per capita on acid reducing drugs$27 $410OthersLansoprazoleOmeprazoleEsomeprazole PantoprazoleRabeprazole10%10%14%16% 17%33%Unrestricted coverageListing status as of December 2006Restricted coverage56% 44%4 Acid reducing drugsTotal spending in BC: $107-millionSpending per capita in BC: $27.17Dispensing fees as percent of spending: 11%Users of treatment per 1,000 pop. in BC: 80Spending per user of treatment in BC: $337.65Days of treatment per user in BC: 185Cost of treatment per day in BC: $1.83t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n2IntroductionU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r s e a r C h3figure 4e» Users of treatment per 1, 00 opulatio  in BC, by age group and primary source of fi ance, 2006Overall spending and useBritish Columbians spent $107-million, or $27.17 per capita, on acid reducing drugs during 2006. In terms of spending per capita, this was the 4th largest therapeu-tic category studied.Approximately 80 out of very 1, 00 BC residents fi lled a prescription for an acid reducing drug in 2006. On average, th se use s r ceived 185 days of treatment in 2006, indicating that many users do not take th se medicines persistently.Leading drugs in classPr ton pump inhibitors accounted for virtually all s ending on acid reducing drugs in BC during 2006.Provincial formulary coverageBC PharmaCare provi ed som  l vel of coverage for all 9 types of acid reducing drug sold in C n da during 2006.Spending and use by ageDuring 2006, the use of and spending on acid reducing drugs in BC increased relatively steadily across all age groups of the opulation. More than 1 perso  in 8 over age 30 fi lled at least one prescription for an acid reducing drug in 2006, and more than 1 in 5 people over 70 years of age id so.Average spending per person by age grou  peaked at $96.28 for the c hort aged 80+. Because of their relative opulation size, how ver, the age groups 50–59, 60–69, and 70–79 all accounted for a greater share of total spending in this category. Notably, all three of those age groups accounted for 21% of total spending.Wit  the exception of costs for persons over age 70, mo t spending on drugs in this class came from privately sources of fi ance.Numberof eopleAge group0-9Numberof eopleAge group361,726 4 9,846 501,728 530,510 657,126 594,597 376,293 251,62 172,9630-19 0-29 0-39 0-49 0-59 0-69 0-79 80+Spending per capita$100$75$50$250-9361,726 4 9,846 501,728 530,510 657,126 594,597 376,293 251,62 172,9630-19 0-29 0-39 0-49 0-59 0-69 0-79 80+Users of treatment per 1,000 population24018012060$0.7770% private;30% public82% private;18% public86% private;14% public$1.40$4.17$1 .30$21.65$38.62$ 9.52$88.17$96.2841%59%46%54%68%32%79%21%79%21%80%20%75% private;25% publicPrivate spe dingPublic spe ding712274774110161223 22540%60%47%53%70%30%83%17%84%16%86%14%86%14%76% private;24% publicU ers for whom >50% of costs were paid privatelyU ers for whom ≥50% of costs were paid publiclyfigure 4d» Spending per capita in BC, by age group and source of fi ance, 2006figure 4C» Percentage of drug types within category that are cov red by BC Pharm Carefigure 4B» Percentage of spending within category by specifi c drug typesfigure 4a» Spending within category relative to otal spending on all prescription drugsOthers 10%Lansoprazole 10%Omeprazole 14%Esomeprazole 16%Pantoprazole 17%Rabeprazole 33%Total drug spe dingper capitaSpe ding per capita on acid reducing drugs$27 $410OthersLansoprazoleOmeprazoleEsomeprazole PantoprazoleRabeprazole10%10%14%16% 17%33%Unres ricted coverageListing status as of December 2006Res ricted coverage56% 44%Common goal of therapyTre t and pr vent the risk of ulcers and • damage to esophagus due to acid refl uxExamples of indicated conditionsAcid refl ux• Peptic ulcer• Numberof eopleAge group0-9Numberof eopleAge group361,726 4 9,846 501,728 530,510 657,126 594,597 376,293 251,62 172,9630-19 0-29 0-39 0-49 0-59 0-69 0-79 80+Spending per capita$100$75$50$250-9361,726 4 9,846 501,728 530,510 657,126 594,597 376,293 251,62 172,9630-19 0-29 0-39 0-49 0-59 0-69 0-79 80+Users of treatment per 1,000 population24018012060$0.7770% private;30% public82% private;18% public86% private;14% public$1.40$4.17$1 .30$21.65$38.62$ 9.52$88.17$96.2841%59%46%54%68%32%79%21%79%21%80%20%75% private;25% publicPrivate spe dingPublic spe ding712274774110161223 22540%60%47%53%70%30%83%17%84%16%86%14%86%14%76% private;24% publicU ers for whom >50% of costs were paid privatelyU ers for whom ≥50% of costs were paid publiclyOthers 10%Lansoprazole 10%Omeprazole 14%Esomeprazole 16%Pantoprazole 17%Rabeprazole 33%Total drug spe dingper capitaSpe ding per capita on acid reducing drugs$27 $410OthersLansoprazoleOmeprazoleEsomeprazole PantoprazoleRabeprazole10%10%14%16% 17%33%Unres ricted coverageListing status as of December 2006Res ricted coverage56% 44%4 Acid reducing drugsTotal spending in BC: $107-m llionSpending per capita in BC: $2 .17Dispensing fees as percent of spending: 11%Users of treatment per 1, 0  pop. in BC: 80Spending per user of treatment in BC: $337.65Days of treatment per user in BC: 185Cost of treatment per day in BC: $1.83Results by therap utic categoryThe atlas contains 21 r lated 1-page chapters on varia-tions in the use of and spending on prescription drugs: one for all types of prescription drug combined, and 20 for the top therapeutic categories in drug treatment (grouped by major treatment area). The following information is provided in each of these chapters:1.   Summary information about the therapeutic category—Includes province-wide statistics on spending and use, a pie chart depicting leading drug types, and a pie chart illustrating the shares of drugs covered by BC PharmaCare.2.   Average age-specific spending on prescription drugs within the therapeutic category—Bars in this chart are proportional to the BC population in the age groups, giving a visual indication of the relative shares of total spending by age group. Spending in this chart is categorized into public spending by BC PharmaCare and private spending (which includes private insur-ance and out-of-pocket costs combined).3.   Age-specific use of prescriptions within the thera-peutic category—Bars in this chart are proportional to the BC population in the age groups, giving a visual indication of the relative shares of all users by age group. Users are categorized by whether or not they are “primarily public beneficiaries,” in the sense that at least 50% of the costs of their prescriptions (from the therapeutic class) are paid for by BC PharmaCare.4.   Text summarizing key information about the therapeutic category.Regional variation mapsThe main component of each chapter is a series of two-page spreads relating to the four components of prescription drug use and cost studied in the atlas: prescription drug spending per capita, the number of users of treatment per 1,000 residents, the average number of days of treatment received per user of therapy, and the average cost of treatment per day. The following information is provided in each of the two-page spreads:11223344U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 5t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n6Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h7table 4e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20064 Acid reducing drugsSources of spending deviation Aft er accounting for diff erences in population age, sex, and health status, variations across BC’s LHAs in spending per capita on acid-reducing drugs in 2006 resulted from the combined eff ects of variations in the share of the population who fi lled one or more prescription for them and variations in the number of days of acid-reducing treatment received per user.Some LHAs where use diff ered signifi cantly from rates predicted based on provincial averages for populations of the same age, sex, and health status did not have statistically signifi cant diff erences in spending. Th is is largely because our methods for estimating spending per capita involve an adjustment for selection bias that reduces confi dence intervals for estimates from that model.Lake CowichanSookeCampbell RiverGreater VictoriaNanaimoQualicumSaanichCowichanLadysmithCourtenayAlberniIsland NorthGulf IslandsLillooetTrailWindermereKeremeosKimberleyKamloopsSalmon ArmCranbrookCentral OkanaganArmstrongSummerlandPentictonSouth OkanaganMerrittVernonArrow LakesCastlegarKootenay LakeCrestonGrand ForksKettle ValleySouth CaribooGoldenNelsonEnderbyCariboo–ChilcotinRevelstokeNorth ThompsonPrinceton100 Mile HouseBurns LakeKitimatPeace River NorthSmithersTerracePrince RupertFort NelsonPrince GeorgeNechakoQuesnelPeace River SouthAgassiz–HarrisonLangleyChilliwackAbbotsfordNew WestminsterDeltaHopeMaple RidgeMissionSurreyCoquitlamBurnabySouth Surrey–White RockPowell RiverSunshine CoastWest Van.–Bowen IslandVancouver City CentreVan. Downtown EastsideNorth VancouverRichmondVancouver MidtownVancouver SouthVancouver North EastVancouver WestsideHowe Sound23%8%5%2%0%0%0%-1%-3%-4%-5%-12%-12%19%12%0%0%-1%-10%-11%-13%-15%-16%-19%-23%10%7%8%0%0%0%9%8%10%-13%-6%-12%0%13%3%-10%0%-7%-3%-21%-20%-27%-27%-9%-8%0%0%-5%-5%0%1%-9%0%-3%-2%4%1%-3%0%-2%7%2%-11%4%-1%-5%-2%-7%5%-4%18%4%4%4%-6%-7%0%-4%-6%0%-5%-10%-14%15%11%-25%-10%4%-11%-6%-7%-8%-8%-19%-21%24%19%13%7%7%7%5%3%1%0%0%0%-8%34%33%30%22%19%19%18%18%13%11%7%6%5%1%1%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%38%28%28%9%5%0%0%0%0%0%0%9%16%9%11%8%13%10%11%11%11%5%0%0%-10%8%8%16%12%8%10%11%10%10%5%8%6%8%10%7%0%0%0%0%0%0%0%6%9%0%0%0%9%13%0%16%0%0%11%0%-18%0%0%5%7%20%12%8%2%4%0%0%0%0%-3%5%13%-12%36%32%23%20%14%16%15%13%7%7%0%3%0%0%-3%0%25%21%13%8%0%0%-24%12%13%16%30%12%42%12%42%20%30%6%0%15%63%5%13%19%24%0%3%2%5%-5%2%5%4%0%-3%-8%0%0%0%-6%4%-9%0%2%3%0%9%0%4%0%3%0%-1%0%0%0%-4%-5%0%0%5%-3%-5%-5%-4%-7% -4%-7%-8%16%-10%8%-7%0%8%-7%-6%-10%-12%t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n4Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual valuefor LHAPredictedvaluefor LHALog.devi-ationLocal health areaActual valuefor LHAPredictedvaluefor LHALog.devi-ationU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 4G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 4f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson9117-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%4336Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita91174336Users per 1,0001171912426Days per user8283523359Cost per day1541table 4a» Variation in spending per capita by local health area, 20064 Acid reducing drugsRegional variations in spending per capitaAft er accounting for diff erences in population age, sex, and health status, spending on acid-reducing drugs varied moderately across BC’s LHAs in 2006.In 43 LHAs, spending on acid-reducing drugs was within 5% of (or not statistically signifi cantly diff erent from) levels predicted based on provincial averages for populations of the same age, sex, and health status.With the exception of Powell River and Sunshine Coast, levels of spending per capita on acid-reducing drugs in Vancouver Coastal LHAs were generally lower than levels predicted based on provincial averages for populations of the same age, sex, and health status.Lake CowichanSookeCampbell RiverGreater VictoriaNanaimoQualicumSaanichCowichanLadysmithCourtenayAlberniIsland NorthGulf IslandsLillooetTrailWindermereKeremeosKimberleyKamloopsSalmon ArmCranbrookCentral OkanaganArmstrongSummerlandPentictonSouth OkanaganMerrittVernonCrestonKootenay LakeNelsonCastlegarArrow LakesGrand ForksKettle ValleyPrincetonGoldenRevelstoke100 Mile HouseNorth ThompsonCariboo–ChilcotinSouth CaribooEnderbyBurns LakeKitimatPeace River NorthSmithersTerraceQuesnelPrince RupertNechakoPrince GeorgePeace River SouthFort Nelson$37.9$32.7$33.9$35.2$33.8$47.8$40.6$34.7$37.9$32.9$28.8$26.2$30.2$31.1$40.8$29.2$44.6$33.7$32.6$40.0$33.1$37.4$33.3$37.8$37.1$43.3$36.3$33.5$35.8$24.6$26.5$33.0$32.3$29.5$29.5$48.5$20.6$28.5$38.6$23.3$26.3$36.4$35.9$33.8$54.8$20.1$25.9$28.5$30.0$25.9$23.4$24.8$25.0$17.3$29.8$27.1$29.7$32.9$31.6$44.7$38.8$33.7$37.4$32.8$27.0$22.5$32.9$22.2$29.4$21.6$35.7$27.9$27.1$33.3$27.5$32.9$29.9$35.4$35.0$41.1$35.9$33.3$31.0$19.6$23.1$25.7$29.3$27.4$28.1$32.3$25.4$20.7$33.7$20.7$22.4$34.1$30.8$23.0$41.3$15.2$23.8$27.1$24.8$22.1$20.2$23.6$19.5$9.124%19%13%7%7%7%5%3%1%0%0%0%-8%34%33%30%22%19%19%18%18%13%11%7%6%5%1%1%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%38%28%28%9%5%0%0%0%0%0%0%Agassiz–HarrisonLangleyChilliwackAbbotsfordHopeDeltaNew WestminsterMaple RidgeMissionSurreyCoquitlamBurnabySouth Surrey–White RockPowell RiverSunshine CoastWest Van.–Bowen IslandVancouver City CentreVan. Downtown EastsideNorth VancouverRichmondVancouver MidtownVancouver SouthVancouver North EastVancouver WestsideHowe Sound$30.4$26.8$29.1$27.0$35.1$25.1$27.3$27.3$27.2$21.1$21.0$22.3$31.5$42.5$34.5$27.8$22.5$25.2$25.0$18.7$17.2$19.0$17.8$19.7$14.4$24.2$24.8$27.7$26.5$35.9$26.8$28.7$27.6$28.1$21.9$22.0$25.1$35.6$35.0$30.4$35.6$24.7$25.4$27.5$21.0$19.6$22.0$20.8$23.9$18.123%8%5%2%0%0%0%-1%-3%-4%-5%-12%-12%19%12%0%0%-1%-10%-11%-13%-15%-16%-19%-23%t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n4Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health reaActual valuefor LHAPredictedvaluefor LHALog.devi-ationLocal health reaActual valuefor LHAPredictedvaluefor LHALog.devi-ationU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r s e a r C h5Relatively igh given the ag , sex, and heal h status of LHA residentsRelatively low given the ag , sex, and heal h status of LHA residentsLHAs have be n r sized torepresent their population.1,000 eopleD ta are unre iablefigure 4G» Extent of regional variation» Number of local health areas with given dev ations of actual values from pred ctions based on provinci l averages for opulations of the same age, sex, and health status, 2006figure 4f» Regional variatio  in spending per capita» Dev ation of actual values for local health areas from pred ctions based on provinci l averages for opulations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQu snelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGr aterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSu shineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookF rnieWind mereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonP ace RiverNorthP ace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson9117-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%4336Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per c pita91174336Users per 1,0001171912426Days per user8283523359Cost per day1541table 4a» Variatio  in spending per capita by local health area, 20064 Acid reducing drugsRegional variations in spending per capitaAft er accounting for diff rences in opulation age, sex, and health statu , spending on acid-reducing drugs varied moderately across BC’s LHAs in 2006.In 43 LHA , spending on acid-reducing drugs was within 5% of (or no  sta stically signifi cantly diff rent from) l vels predicted based on provinci l averages for opulations of the same age, sex, and health status.Wit  the exception of Powell River and Sunshine Coast, l vels of spending per capita on acid-reducing drugs in Vancouver Coastal LHAs w re g nerally lower than l vels predicted based on provincial averages for opulations of the same age, sex, and health status.Lake CowichanSookeCampbell RiverGr ater VictoriaNanaimoQualicumSaanichCowichanLadysmithCourtenayAlberniIsland NorthGulf IslandsLillooetTrailWindermereKer meosKimberleyKamloopsSalmon ArmCranbrookCentral OkanaganArmstrongSummerlandPentictonSouth OkanaganMerrittVer onCrestonKootenay LakeNelsonCastlegarArrow LakesGrand ForksKettle ValleyPrincetonGoldenRevelstoke100 Mile HouseNort  ThompsonCariboo–ChilcotinSouth CaribooEnderbyBurns LakeKitimatPeace River NorthSmithersTerraceQuesnelPrince RupertNechakoPrince GeorgePeace River SouthFort Nelson$37.9$32.7$33.9$35.2$33.8$47.8$40.6$34.7$37.9$32.9$28.8$ 6.2$30.2$31.1$40.8$ 9.2$44.6$33.7$32.6$40.0$33.1$37.4$ 3.3$37.8$37.1$43.3$ 6.3$33.5$35.8$24.6$26.5$33.0$ 2.3$29.5$29.5$48.5$20.6$28.5$38.6$23.3$26.3$36.4$35.9$33.8$54.8$20.1$25.9$28.5$30.0$25.9$23.4$24.8$25.0$17.3$29.8$27.1$29.7$32.9$31.6$44.7$38.8$33.7$37.4$32.8$27.0$22.5$32.9$ 2.2$29.4$21.6$35.7$27.9$27.1$ 3.3$27.5$32.9$29.9$35.4$35.0$41.1$35.9$ 3.3$31.0$19.6$23.1$25.7$29.3$27.4$28.1$ 2.3$25.4$20.7$33.7$20.7$22.4$34.1$30.8$23.0$41.3$15.2$23.8$27.1$24.8$22.1$ 0.2$23.6$19.5$9.124%19%13%7%7%7%5%3%1%0%0%0%-8%34%33%30%22%19%19%18%18%13%11%7%6%5%1%1%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%38%28%28%9%5%0%0%0%0%0%0%Agassiz–HarrisonLangleyChilliwackAbbotsfordHopeDeltaNew WestminsterMaple RidgeMissionSurreyCoquitlamBurnabySouth Surrey–White RockPowell RiverSunshine CoastWest Van.–Bowen IslandVancouver City CentreVan. Downtown EastsideNorth VancouverRichmondVancouver MidtownVancouver SouthVancouver North EastVancouver WestsideHowe Sound$30.4$26.8$29.1$27.0$35.1$25.1$27.3$27.3$ 7.2$21.1$21.0$22.3$31.5$42.5$34.5$27.8$22.5$ 5.2$25.0$18.7$17.2$19.0$17.8$19.7$14.4$ 4.2$24.8$27.7$26.5$35.9$26.8$28.7$27.6$28.1$21.9$22.0$25.1$35.6$35.0$30.4$35.6$24.7$25.4$27.5$21.0$19.6$22.0$20.8$23.9$ 8.123%8%5%2%0%0%0%-1%-3%-4%-5%-12%-12%19%12%0%0%-1%-10%-11%-13%-15%-16%-19%-23%5.   Text summarizing key information about variations in the relevant component of prescription drug use and cost. 6.   A table listing actual and predicted values for BC LHAs—For each LHA grouped by health authority, this table lists the actual value of the relevant measure (spending, users, days, or cost); what the province-wide statistical model predicts for each LHA given the age, sex, and health status of its population; and the extent to which those two measures differ.7.   A mapping of regional variations using the carto-gram of BC LHAs—Scaled by population size, LHAs in this map are coloured based on the extent to which the relevant measures (spending, users, days, or cost) differ from the provincial averages for populations of the same age, sex, and health status. 8.   Histograms—These horizontal bar graphs depict the distribution of regional variations in each of the four measures studied in the chapter for quick com-parison across the measures.Summary of variations9.   For each LHA, we list the extent to which the four measures of use and cost differ from levels predicted based on provincial averages for populations of the same age, sex, and health status. Data presented in this way provides a visual indication of the extent to which variations in spending per capita are driven by varia-tions in rates of use, days per user, or costs per day. 668775599t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 6The importance of “fair comparisons”Importance of age, sex, and health statusWhen making regional comparisons about the use of and spending on prescription drugs (or any other health care service), it is important to take into account factors that might cause legitimate differences in what is being measured.A key “finding” in this atlas is that prescription drug use and spending varies dramatically across LHAs when measured on a simple per capita basis. In every therapeutic category, there were very significant differences in the actual rates of prescription use and amounts spent on prescriptions by average residents across BC’s LHAs.However, it is inappropriate to draw too much atten-tion to differences in simple averages across LHAs because the populations of LHAs differ in ways that are important determinants of prescription drug use and spending. Consider age, sex, and health status:As shown in this atlas, to varying extents across • therapeutic categories, there are differences in the use and cost of prescription drugs across age groupsPatterns of prescription drug use and costs also • differ for women and men, and these differences also vary by therapeutic categoryFinally, all persons of a given age and sex do not • have the same health needs. Differences in health status often translate into differences in needs for prescription drugs, or into needs for different prescription drugs.In building our province-wide statistical models, we found that age, sex, and our measures of health status were very useful for predicting an individual’s prescription drug spending and the related factors measured in this atlas (use of prescriptions, days of therapy received, and cost per day).To the extent that (1) these factors are important determinants of prescription drug spending and use for individuals, and (2) regional populations differ systematically in any of these factors, it would probably be desirable for average amounts of prescription drug spending and use in regions to also differ.Other factorsTo make “fair comparisons” across BC’s LHAs, we adjusted all of our analyses for the age, sex, and health needs of residents within each LHA. However, we also chose not to adjust models for some variables that might also influence prescription drug spending. Most notably, we did not adjust our province-wide statistical models for the estimated incomes of each resident.Although income is a known determinant of access to medicines and may influence the type of medicines prescribed to and used by individuals, we did not wish to “hide” income-related variations in medicine use across BC’s LHAs by way of our statistical models. Indeed, some of the results in this atlas—see, for example, chapters on cholinesterase inhibitors and erectile dysfunction drugs—appear to illustrate regional variations that are at least partly income-driven.We also did not adjust for socio-cultural characteristics of BC residents, including ethnicity and immigration. This was in part because data on ethnicity and immi-gration are not systematically collected in BC—not, at least, within health care databases—making it impos-sible to incorporate these factors into our province-wide statistical model. However, leaving socio-cultural characteristics and income out of our models also ensured that regional variations driven by these factors are not hidden by the methods used.U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 7Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson12161265Indicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%15134152Indicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%355figure B» Age, sex, and health status adjusted variation in spending per capita on antihypertensives, 2006figure a» Unadjusted variation in spending per capita on antihypertensives, 2006Adjustments matterFigures A and B map regional variations in spending per capita on antihypertensives onto the cartogram of BC that is used throughout this atlas.Figure A illustrates unadjusted variations across BC’s LHAs in spending per capita on antihypertensives in 2006. As with most of the maps in this atlas, it illustrates the extent of deviation of actual values from predictions for each LHA. In this case, the level “predicted” for each region is simply the provincial average level because no adjustments are made for age, sex, or health status.This unadjusted map shows dramatic variation across BC’s LHAs in spending per capita on antihyperten-sives. Much of that variation, however, is the result of systematic differences in population characteristics that are associated with the need for antihypertensives (most notably age and health status).Contrast the map of unadjusted variations in Figure A with Figure B, which illustrates variations across BC’s LHAs in spending per capita on antihyperten-sives in 2006 after differences in population age, sex, and health status are accounted for. Most of the regional variation disappears with the adjustment. Perhaps most importantly for informing and improving pharmaceutical practice and policy, some of the regions that were “below average” in the unadjusted illustration are, in fact, “above average” given the population age, sex, and health status of area residents.Because it is important to identify variations in prescription drug use and spending that are due to factors other than obvious need, all results mapped in this atlas are those that account for differences in population age, sex, and health status.t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 8Key findingsfigure a» Spending per capita in BC, by age group and source of finance, 2006Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$1,200$900$600$3000-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population1,000750500250$50$86$163$233$340$545$813$1,152$1,18540%60%45%55%62%38%70%30%65%35%65%35%65%35%80% private;20% public82% private;18% publicPrivate spendingPublic spending551517618 64066073883089080439%61%49%51%75%25%88%12%89%11%90%10%87%13%90%10%90%10%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclySpending and use by age groupA total of $1.6 billion, or $410 per capita, was spent on prescription drugs in British Columbia (BC) in 2006. Spending per elderly resident of BC was much higher than spending per younger person (Figure A). On average, BC residents aged 70 and older filled more than $1,100 worth of prescriptions, while residents under age 30 filled less than $200 worth of prescrip-tions on average.Although average spending was highest among the oldest age groups, the cohort of residents aged 50–59 accounted for the largest share (20%) of total spending on prescription drugs. This is because they represent both a high spending age category and a large share of the total BC population. A majority of residents in every age category filled at least one prescription during 2006 (Figure B). Resi-dents aged 70–79 were most likely to fill at least one prescription. Those aged 10-19 were least likely to have filled at least one prescription.Because the universal drug plan under BC Pharma-Care involves income-based deductibles, most of the cost of prescription drugs used by BC residents under age 70 was financed privately in 2006, either through insurance or out of pocket. A majority of costs for resi-dents aged 70 and older are financed publicly, because deductibles under the universal program are relatively low for that generation of residents.Spending and use by therapeutic categoryAlmost half of all prescription spending in BC in 2006 was on cardiovascular and neurological drugs (Table A). A total of $450 million, or $114 per capita, was spent on cardiovascular drugs, and $305 million, or $77 per capita, was spent on neurological medicines.The most commonly used category of drug was antibiotics, at least one of which was used by roughly one third of all BC residents.Hypertension drugs—used by more than one in three BC residents aged 50 and older—were the second most commonly used category of medicines.U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 9table a» Summary of provincial averages for different measures of prescription drug use and spending by therapeutic category, 2006Therapeutic categorySpendingper capitaUsers per1,000 residentsDaysper userCost  per dayAll prescription drugs on the market $409.93 673 467 $1.30Cardiovascular: Antihypertensives $68.08 149 507 $0.90Cardiovascular: Statins $38.43 72 285 $1.87Cardiovascular: Antithrombotics $7.72 21 305 $1.21Neurological: Antidepressants $35.14 97 266 $1.36Neurological: Antipsychotics $19.19 20 275 $3.40Neurological: Gabapentin, pregabalin, topiramate $7.13 14 179 $2.74Neurological: Benzodiazepines and related drugs $7.04 84 144 $0.58Neurological: Cholinesterase inhibitors $3.04 0 256 $4.90Neurological: Drugs for Parkinson’s disease $2.96 3 312 $2.90Neurological: Psychostimulants $2.96 6 224 $2.10Acid-reducing drugs $27.17 80 185 $1.83Analgesics: Opioid drugs $12.23 115 48 $2.22Analgesics: Nonsteroidal anti-inflammatory drugs $7.56 109 56 $1.23Inhaled drugs for respiratory conditions $16.70 66 153 $1.65Diabetes: Oral drugs $10.92 33 428 $0.78Diabetes: Insulins $5.42 9 254 $2.43Oral antibiotics $16.32 333 19 $2.52Hormonal contraceptives $15.17 103 238 $0.62Drugs for erectile dysfunction $9.91 35 29 $9.91Bisphosphonates $6.99 26 268 $1.02figure B» Users of treatment per 1,000 population in BC, by age group and primary source of finance, 2006Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$1,200$900$600$3000-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population1,000750500250$50$86$163$233$340$545$813$1,152$1,18540%60%45%55%62%38%70%30%65%35%65%35%65%35%80% private;20% public82% private;18% publicPrivate spendingPublic spending551517618 64066073883089080439%61%49%51%75%25%88%12%89%11%90%10%87%13%90%10%90%10%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n2 0Key findings (continued)Nonsteroidal anti-inflammatory drugs, opioid anal-gesics, and antidepressants were all commonly used, especially by residents aged 50 and older.Regional variationsOur results reveal often-significant regional varia-tions in spending per capita on prescription medi-cines in BC. However, the extents of these variations differ across therapeutic categories: with spending on some types of medicine being relatively uniform across BC’s LHAs after we accounted for differ-ences in population age, sex, and health status; and spending on other categories varying greatly.To illustrate differences in the extent of regional variations for all medicines combined and for each therapeutic category, the first numeric column Table B lists the coefficient of variation (across LHAs) in age-, sex-, and health-status-adjusted spending per capita. (While this statistic is not used elsewhere in the report, it summarizes the extent of regional varia-tion in a way that is comparable across categories.)After we accounted for differences in population age, sex, and health status, there were only modest varia-tions across BC’s LHAs in spending per capita on all prescription drugs combined. However, beneath the surface of relatively even overall prescription drug spending across BC’s LHAs lay significant variations in spending per capita for almost all of the prescrip-tion drug categories studied in this atlas.Spending per capita on bisphosphonates varied more across BC’s LHAs than spending on any other therapeutic category. Levels of spending on various types of neurological drugs and analgesics were also more highly varied than spending on other categories of treatment, such as oral antibiotics and cardiovas-cular drugs.Table C provides comparable measures of variation for medical and hospital services. This shows that the spending per capita on prescription drugs—overall and in each therapeutic category—varied more across BC’s LHAs than spending per capita on medical services from all providers, medical services from general practitioners, and medical services from diagnostic specialists.Variations in spending per capita on services from surgical specialists across BC’s LHAs were compa-rable to variations in prescription drug spending. However, variations in spending per capita on services from medical specialists and hospital care (inpatient care and/or hospital day surgery) were generally greater than variations in spending per capita on prescription drugs.Sources of variationOur analysis depicts not only the extent of variation in spending per capita but also variations in key determinants of spending: use of medicines, days per user, and cost per day. For all medicines combined and for each therapeutic category, the last three columns of Table B provide coefficients of variation (across LHAs) in age-, sex-, and health-status-adjusted use, days, and costs. (While coefficients of variation are not used elsewhere in the report, they summarize the extent of regional variation in a way that is comparable across categories and measures: i.e., use, days, costs.)These columns in Table B also show that, after dif-ferences in the age, sex, and health status of residents are accounted for, variations across BC’s LHAs in spending per capita on prescription drugs are domi-nated by variations in the number of people receiving one or more prescriptions of a given type. U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h2 1table B» Overall extent of regional variation* for different measures of prescription drug use and spending by therapeutic category, 2006Therapeutic categorySpendingper capitaUsers per1,000 residentsDaysper userCostper dayAll prescription drugs on the market 5% 3% 7% 5%Cardiovascular: Antihypertensives 7% 8% 4% 5%Cardiovascular: Statins 9% 14% 2% 4%Cardiovascular: Antithrombotics 9% 18% 7% 12%Neurological: Antidepressants 15% 16% 6% 6%Neurological: Antipsychotics 14% 20% 12% 12%Neurological: Gabapentin, pregabalin, topiramate 15% 24% 7% 10%Neurological: Benzodiazepines and related drugs 15% 13% 10% 9%Neurological: Cholinesterase inhibitors 16% 40% 9% 5%Neurological: Drugs for Parkinson’s disease 13% 17% 12% 18%Neurological: Psychostimulants 10% 18% 5% 11%Acid-reducing drugs 12% 14% 9% 5%Analgesics: Opioid drugs 16% 15% 21% 13%Analgesics: Nonsteroidal anti-inflammatory drugs 15% 17% 11% 7%Inhaled drugs for respiratory conditions 12% 14% 10% 7%Diabetes: Oral drugs 7% 12% 3% 11%Diabetes: Insulins 14% 24% 11% 11%Oral antibiotics 8% 7% 6% 7%Hormonal contraceptives 11% 14% 5% 3%Drugs for erectile dysfunction 10% 14% 11% 8%Bisphosphonates 18% 28% 4% 5% * Extent of regional variation is summarized here using coefficient of variation across all regions’ age, sex, and health status adjusted measures.Service TypeSpendingper capitaUsers per1,000 residentsUnits of serviceper userCost perunit of serviceMedical services from all providers 2% 3% 9% 4%Medical services from general practitioners 3% 1% 5% 7%Medical services from diagnostic specialists 6% 5% 10% 7%Medical services from surgical specialists 13% 13% 10% 11%Medical services from medical specialists 22% 22% 20% 11%Hospital services: inpatient care and day procedures 15% 15% 12% 8%Hospital services: inpatient care 18% 18% 11% 8%Hospital services: day procedures 18% 19% 1% 12%* Extent of regional variation is summarized here using coefficient of variation across all regions’ age, sex, and health status adjusted measures.table C» Overall extent of regional variation* for different measures of medical and hospital service use and spending by service type, 2006t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n2 2Key findings (continued)Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonIndicates one LHA7315-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Overall use Antidepressants use Psychostimulants use Bisphosphonates useIndicates one LHA18102563413 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%510755344 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Indicates one LHA Indicates one LHA5349152221 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonIndicates one LHA7315-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Overall use Antidepressa s use Psychostimulants use Bisphosphonates useIndicates one LHA18102563413 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%510755344 -5 to +5%+6 to +15%+16 to +2 %> +25%-15 to -6%< -25%-25 to -16%Indicates one LHA Indicates one LHA5349152221 -5 to +5%+6 to +15%+16 to +2 %> +25%-15 to -6%< -25%-25 to -16%figure d» Variation in number of users of antidepressants per 1,000 residents, 2006figure C» Variation in number of users of all prescription drugs per 1,000 residents, 2006The variations in the rate of use of prescriptions from several therapeutic categories that remain after we accounted for differences in population age, sex, and health status are sufficiently large to justify further exploration of their underlying clinical justification, potential non-clinical causes, and impacts on the health status of populations. One of our most surprising findings is that variations across BC’s LHAs in the cost per day of treatment were relatively modest across many therapeutic categories. This was unexpected because, within almost all therapeutic categories studied, there are significant differences in the cost of different drugs that could be used (ranging from low cost generic versions of older medicines to high cost brand-name versions of patented drugs). For patients of similar age, sex, and health status, there are only moderate differences in cost of treatments chosen across BC’s LHAs.Patterns of variationWhereas Figure C shows how little the use of at least one prescription of any kind varies across BC, Figures D, E, and F illustrate three examples of category-specific patterns of prescription drug use found in BC in 2006.As with many of the patterns of prescription drug use illustrated in this atlas, patterns in the use of these examples—antidepressants, psychostimulants, and bisphosphonates—appear to follow lines of urban/rural and northern/southern divides.In most of the therapeutic categories studied—includ-ing antidepressants and psychostimulants—residents of LHAs within and around the city of Vancouver use medicines less often than predicted based on provin-cial averages for populations of the same age, sex, and health status. This is a pattern of regional variation found in many therapeutic categories in this atlas. U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h2 3Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonIndicates one LHA7315-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Overall use Antidepressants use Psychostimulants use Bisphosphonates useIndicates one LHA18102563413 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%510755344 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Indicates one LHA Indicates one LHA5349152221 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelsonIndicates one LHA7315-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Overall use Antidepressants use Psychostimulant  use Bisphosphonates useIndicates one LHA18102563413 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 t  -16%510755344 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 t  -16%Indicates one LHA Indicates one LHA5349152221 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%figure f» Variation in number of users of bisphosphonates per 1,000 residents, 2006figure e» Variation in number of users of psychostimulants per 1,000 residents, 2006Moreover, after we accounted for differences in popu-lation age, sex, and health status, residents of the LHAs with the highest rates of immigration from Asia—e.g., Richmond, South Vancouver, Vancouver Northeast (see Appendix I: Asian Immigration)—use many types of medicine the least often of all LHAs in BC. The patterns of antidepressant and psychostimulant use illustrate this.Bisphosphonates pose a fascinating contrast: residents of LHAs within and around the city of Vancouver use bisphosphonates— unlike most other categories of drug—far more often than predicted based on provin-cial averages for populations of the same age, sex, and health status. It is as yet unknown whether this reflects unobserved variation in needs for such treatment (e.g., driven by ethnic differences in risk of osteoporosis) or regional variation in access to related diagnostic tests.t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n2 4U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h2 51All prescription drugs on the markett h e  B C  r x  a t l a s ,  2 n d  e d i t i o n2 6Introductionfigure 1d» Spending per capita in BC, by age group and source of finance, 2006figure 1B» Percentage of spending by specific drug types, 20061 All prescription drugs on the marketNumberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$1,200$900$600$3000-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population1,000750500250$50$86$163$233$340$545$813$1,152$1,18540%60%45%55%62%38%70%30%65%35%65%35%65%35%80% private;20% public82% private;18% publicPrivate spendingPublic spending551517618 64066073883089080439%61%49%51%75%25%88%12%89%11%90%10%87%13%90%10%90%10%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyTotal spending in BC: $1.6-billionSpending per capita in BC: $409.93Dispensing fees as percent of spending: 18%Users of treatment per 1,000 pop. in BC: 673Spending per user of treatment in BC: $608.93Days of treatment per user in BC: 467Cost of treatment per day in BC: $1.30OtherNeurological: AntipsychoticsAcid reducing drugsNeurological: AntidepressantsCardiovascular: StatinsCardiovascular: AntihypertensivesOthersAntihypertensivesStatinsAcid reducing drugsAntipsychoticsAntidepressants17%54%7%5%9%9%OtherAdministrationPublic healthCapitalOther institutionsOther health professionalsPharmaceuticalsPhysiciansHospitalsCapitalHospitalsPhysiciansOther health professionalsOther institutionsOtherAdministrationPublic healthPharmaceuticals25%6%6%4%7%13%10%14%15%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered10%30%60%OtherNeurological: AntipsychoticsAcid reducing drugsNeurological: AntidepressantsCardiovascular: StatinsCardiovascular: AntihypertensivesOthersAntihypertensivesStatinsAcid reducing drugsAntipsychoticsAntidepressants17%54%7%5%9%9%OtherAdministrationPublic healthCapitalOther institutionsOther health professionalsPharmaceuticalsPhysiciansHospitalsCapitalHospitalsPhysiciansOther health professionalsOther institutionsOtherAdministrationPublic healthPharmaceuticals25%6%6%4%7%13%10%14%15%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered10%30%60%figure 1C» Percentage of drug types that are covered by BC PharmaCare, 2006figure 1a» Spending on types of health care as a share of total health care spending in BC, 2006Source: Data table D1, Canadian Institute for Health Information, National Health Expenditure Trends, 1975–2008 (Ottawa, Ont.: CIHI, 2008).U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h2 7figure 1e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useApproximately two out of every three British Columbia (BC) residents filled at least one prescrip-tion in 2006. The total cost of these prescriptions was $1.6 billion, or about $410 per capita. Dispensing fees accounted for 18% of these costs.Leading therapeutic classes Antihypertensives, statins, antidepressants, and acid reducing medicines were the four leading therapeutic classes in terms of total spending. Together, these four therapeutic categories accounted for 42% of all spending on prescription drugs in BC in 2006.Provincial formulary coverageBC PharmaCare provided unrestricted coverage for 476 of the 796 different types of drug sold in Canada in 2006. PharmaCare provided coverage with various restrictions for an additional 77 types of drug.Spending and use by ageWhile average spending per person was highest among the oldest residents, the cohort of residents aged 50–59 accounted for the largest share (20%) of total spending on prescription drugs. This is because this cohort not only consumes a relatively large volume of medicines (in dollar terms), but is also the second largest age cohort in the province.Public subsidies represented a greater share of spending for residents aged 70 and older. This is because of residual effects of age-based coverage policies pre-dating the Fair PharmaCare program. Age differences in the use of one or more medi-cines are not as great as age differences in costs. This is because of differences in the number, duration, and cost of treatments used by residents in different age groups.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$1,200$900$600$3000-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population1,000750500250$50$86$163$233$340$545$813$1,152$1,18540%60%45%55%62%38%70%30%65%35%65%35%65%35%80% private;20% public82% private;18% publicPrivate spendingPublic spending551517618 64066073883089080439%61%49%51%75%25%88%12%89%11%90%10%87%13%90%10%90%10%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n2 8Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 1a» Variation in spending per capita by local health area, 20061 All prescription drugs on the marketRegional variations in spending per capitaWhile unadjusted spending per capita varied widely across BC’s Local Health Areas (LHAs) in 2006, there was only modest regional variation in overall spending per capita on prescription drugs after differences in population age, sex, and health status had been accounted for.Spending per capita in 63 LHAs was either within 5% of, or was not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Spending per capita levels in South Vancouver, Richmond, and Burnaby were below levels predicted based on provincial averages.AlberniIsland NorthLadysmithLake CowichanNanaimoSaanichGreater VictoriaSookeCowichanGulf IslandsCampbell RiverQualicumCourtenayKootenay LakePrincetonKamloopsCranbrookTrailWindermereCariboo–ChilcotinLillooetRevelstokeCastlegarKeremeosKimberleyPentictonSummerlandSouth OkanaganSalmon ArmMerrittCentral OkanaganCrestonGoldenNelsonKettle Valley100 Mile HouseSouth CaribooNorth ThompsonVernonGrand ForksArmstrongEnderbyArrow LakesFort NelsonNechakoKitimatPeace River NorthPeace River SouthPrince GeorgeTerraceQuesnelSmithersPrince RupertBurns Lake$443.9$382.7$484.7$489.8$473.3$530.8$509.0$411.4$466.6$430.9$439.9$553.6$435.2$354.9$688.0$455.4$441.8$523.6$369.7$402.3$452.5$393.7$439.5$579.9$451.7$596.6$538.4$621.8$514.1$501.1$477.4$484.9$316.8$375.8$389.4$463.0$461.7$369.8$481.1$393.0$397.6$469.2$403.5$244.3$315.1$511.0$280.6$360.4$375.1$448.0$429.7$331.2$384.7$389.5$426.6$368.3$468.4$474.9$461.1$518.8$498.2$404.6$460.7$430.0$427.8$560.4$448.0$311.9$618.5$417.5$411.1$493.1$351.1$383.1$431.4$376.1$420.8$556.2$435.2$575.0$520.9$602.0$500.0$491.8$471.0$478.8$312.9$376.6$407.6$451.3$456.8$372.5$486.8$397.9$406.3$480.9$425.0$209.2$288.0$468.4$257.8$335.4$355.5$428.2$415.8$322.0$369.5$368.04%4%3%3%3%2%2%2%1%0%0%-1%-3%13%11%9%7%6%5%5%5%5%4%4%4%4%3%3%3%2%1%1%1%0%0%0%0%-1%-1%-1%-2%-2%-5%16%9%9%8%7%5%5%3%3%0%0%Agassiz–HarrisonLangleyMaple RidgeChilliwackAbbotsfordHopeDeltaNew WestminsterCoquitlamMissionSurreySouth Surrey–White RockBurnabyVan. Downtown EastsidePowell RiverVancouver City CentreSunshine CoastVancouver WestsideWest Van.–Bowen IslandNorth VancouverVancouver MidtownHowe SoundVancouver North EastRichmondVancouver South$486.1$405.8$418.2$441.6$415.7$541.9$387.7$449.8$342.2$420.3$354.3$477.8$345.9$597.8$547.2$428.0$473.1$348.8$438.2$385.8$340.4$270.6$322.2$318.5$329.9$385.1$381.9$405.0$429.2$405.3$530.2$382.1$445.1$340.4$405.6$354.8$480.9$367.9$559.9$523.4$413.3$470.0$350.0$439.8$389.7$346.5$282.8$339.4$337.9$352.623%6%3%3%3%2%1%1%1%0%0%-1%-6%7%4%3%0%0%0%-1%-2%-4%-5%-6%-7%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h2 9figure 3.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 1f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson211633-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita211633Users per 1,0001573Days per user3274081Cost per day12868t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n3 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 1B» Variation in users of treatment per 1,000 residents by local health area, 20061 All prescription drugs on the marketRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status there was very little variation in the shares of populations filling at least one prescrip-tion of any type across BC’s LHAs in 2006.In 73 LHAs, the rates of use of at least one prescription of any type were either within 5% of, or not statistically significantly different from, rates predicted based on provincial averages for populations of the same age, sex, and health status.The rates of use of at least one prescription in Northern LHAs were generally above rates predicted based on provincial averages.AlberniLadysmithCampbell RiverIsland NorthNanaimoLake CowichanSaanichCowichanGulf IslandsSookeGreater VictoriaQualicumCourtenayKootenay LakePrincetonKamloopsCranbrookTrailCariboo–ChilcotinCastlegarWindermereRevelstoke100 Mile HouseSummerlandSouth OkanaganPentictonLillooetKeremeosKimberleySalmon ArmMerrittCentral OkanaganCrestonGoldenSouth CaribooGrand ForksArmstrongVernonNelsonEnderbyNorth ThompsonKettle ValleyArrow LakesFort NelsonNechakoPeace River NorthPeace River SouthBurns LakePrince GeorgePrince RupertKitimatTerraceQuesnelSmithers6916906976576846907126836606796907126645667386976847116686646276506996987287136686996436657256976386396646386736966086576096006266946156316596846586987046816656446756776856466766847126836576836977236855146986616546926546526186416906907237106586906376647236996446346686456807056166766316296596155745916276516386776846686606392%2%2%2%1%0%0%0%0%-1%-1%-1%-3%10%6%5%5%3%2%2%2%1%1%1%1%1%0%0%0%0%0%0%0%0%0%0%-1%-1%-1%-3%-4%-5%-5%12%7%6%5%5%3%3%3%2%1%0%Agassiz–HarrisonLangleyMissionAbbotsfordMaple RidgeChilliwackDeltaSurreyHopeNew WestminsterCoquitlamSouth Surrey–White RockBurnabyVan. Downtown EastsidePowell RiverVancouver City CentreSunshine CoastWest Van.–Bowen IslandVancouver MidtownNorth VancouverVancouver WestsideHowe SoundVancouver North EastRichmondVancouver South68167271270770967369370269568266270962966668765667270164467963063665062263957165169569369666868869769968366371566465167865467470065168864065366865066818%3%2%2%2%1%1%1%0%0%0%-1%-5%2%1%0%0%0%-1%-1%-2%-3%-3%-4%-5%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h3 1Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 1h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson1573 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita211633Users per 1,0001573Days per user3274081Cost per day12868t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n3 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 1C» Variation in days of treatment per user by local health area, 20061 All prescription drugs on the marketRegional variations in days of treatmentAfter we accounted for differences in popula-tion age, sex, and health status, there was notable regional variation across BC’s LHAs in the number of days of treatment received per user of prescrip-tion drugs in 2006.Days of treatment per prescription drug user in several Vancouver Coastal LHAs were below levels predicted based on provincial averages.Days of treatment per prescription drug user in many Interior, Northern, and Vancouver Island LHAs were well above levels predicted based on provincial averages.AlberniNanaimoSookeGreater VictoriaLake CowichanSaanichCampbell RiverIsland NorthCowichanLadysmithCourtenayGulf IslandsQualicumPrincetonKeremeosLillooetKootenay LakeTrailKamloopsCranbrookPentictonWindermereCastlegar100 Mile HouseSummerlandCariboo–ChilcotinSouth CaribooNorth ThompsonRevelstokeSalmon ArmKimberleyCentral OkanaganNelsonSouth OkanaganMerrittCrestonGoldenGrand ForksEnderbyKettle ValleyVernonArmstrongArrow LakesKitimatQuesnelBurns LakePeace River NorthNechakoPeace River SouthTerracePrince GeorgeFort NelsonPrince RupertSmithers9%7%6%6%5%5%4%4%4%3%1%0%-1%22%16%13%12%11%11%11%9%8%6%5%5%5%5%4%4%3%3%2%2%2%0%0%0%0%0%0%-1%-5%-6%15%14%13%13%13%13%9%9%7%3%0%Agassiz–HarrisonHopeChilliwackLangleyMaple RidgeMissionAbbotsfordNew WestminsterSouth Surrey–White RockDeltaCoquitlamSurreyBurnabyPowell RiverVan. Downtown EastsideVancouver City CentreNorth VancouverSunshine CoastVancouver WestsideRichmondHowe SoundWest Van.–Bowen IslandVancouver MidtownVancouver SouthVancouver North East19%12%6%6%2%2%0%0%-2%-3%-5%-8%-11%8%7%6%-3%-3%-4%-8%-9%-10%-11%-15%-16%544541461549559584485431531577521538623707691510505581504502645466522546594479590482453539552524475658509605386539553535535471533525528480367426453505442249441395496505433518529557464416512559515537630570591446446520452451587432492517563456564462437524537513466646516602384533549537541497568450460420323375400460403232427387528621509465444429460489556434389382431601512457433516418412310481388411391436550478437434420458489566449407415482558479431444532433445341533432478459U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h3 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 1i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson3274081-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita211633Users per 1,0001573Days per user3274081Cost per day12868t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n3 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 1d» Variation in cost of treatment per day by local health area, 20061 All prescription drugs on the marketRegional variations in cost per dayThere was very little variation across BC’s LHAs in the cost per day of prescription drug treatment after we accounted for differences in population age, sex, and health status.Average costs per day of treatment in 68 LHAs studied were either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.The average cost per day of treatment in Vancouver Downtown Eastside was notably above the level predicted based on provincial averages.Greater VictoriaSaanichSookeCowichanLake CowichanQualicumCampbell RiverIsland NorthCourtenayLadysmithNanaimoGulf IslandsAlberniSalmon ArmSouth OkanaganMerrittSummerlandPrincetonEnderbyPentictonCentral OkanaganVernonKimberleyWindermereCrestonKootenay LakeNelsonCastlegarKettle ValleyRevelstokeArmstrongNorth ThompsonLillooetKamloopsTrailCranbrookCariboo–ChilcotinGoldenKeremeosArrow Lakes100 Mile HouseSouth CaribooGrand ForksKitimatFort NelsonTerraceSmithersPrince RupertPrince GeorgeQuesnelPeace River SouthBurns LakeNechakoPeace River North$1.34$1.28$1.31$1.29$1.27$1.25$1.30$1.35$1.26$1.22$1.28$1.21$1.18$1.43$1.30$1.36$1.30$1.32$1.29$1.30$1.31$1.29$1.27$1.27$1.26$1.24$1.30$1.27$1.21$1.34$1.25$1.26$1.33$1.30$1.27$1.28$1.26$1.28$1.20$1.21$1.21$1.18$1.14$1.38$1.41$1.30$1.30$1.25$1.29$1.22$1.21$1.19$1.20$1.21$1.30$1.24$1.31$1.29$1.29$1.24$1.31$1.34$1.29$1.25$1.32$1.26$1.29$1.27$1.24$1.30$1.25$1.27$1.26$1.26$1.29$1.28$1.26$1.27$1.25$1.26$1.29$1.27$1.23$1.31$1.26$1.28$1.28$1.31$1.30$1.32$1.30$1.32$1.25$1.27$1.28$1.25$1.26$1.33$1.40$1.33$1.33$1.30$1.35$1.30$1.31$1.29$1.31$1.343%3%0%0%0%0%0%0%-2%-2%-3%-4%-9%12%5%4%4%3%3%3%1%1%0%0%0%0%0%0%0%0%0%0%0%-1%-2%-3%-3%-3%-4%-4%-5%-6%-10%4%0%-2%-2%-4%-4%-6%-8%-8%-9%-10%Agassiz–HarrisonMissionNew WestminsterChilliwackLangleyMaple RidgeCoquitlamSurreyDeltaBurnabyAbbotsfordHopeSouth Surrey–White RockVan. Downtown EastsideSunshine CoastVancouver City CentreWest Van.–Bowen IslandVancouver MidtownVancouver WestsideNorth VancouverPowell RiverHowe SoundVancouver North EastVancouver SouthRichmond$1.35$1.38$1.35$1.29$1.30$1.33$1.33$1.32$1.29$1.28$1.28$1.26$1.21$1.75$1.36$1.43$1.30$1.36$1.32$1.31$1.32$1.37$1.27$1.26$1.24$1.27$1.34$1.33$1.29$1.30$1.34$1.32$1.33$1.30$1.30$1.30$1.31$1.26$1.43$1.29$1.38$1.27$1.34$1.30$1.31$1.32$1.35$1.29$1.29$1.286%3%1%0%0%0%0%-1%-1%-2%-2%-4%-4%20%5%3%3%2%2%0%0%0%-2%-2%-3%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h3 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 1J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson128-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%68Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita211633Users per 1,0001573Days per user3274081Cost per day12868t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n3 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 1e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20061 All prescription drugs on the marketSources of spending deviationAfter we accounted for differences in population age, sex, and health status, regional variations in spending per capita on all prescription drugs observed in BC in 2006 were primarily driven by variations in the number of days of treatment received per prescription drug user.AlberniIsland NorthLadysmithLake CowichanNanaimoSaanichGreater VictoriaSookeCowichanGulf IslandsCampbell RiverQualicumCourtenayKootenay LakePrincetonKamloopsCranbrookTrailWindermereCariboo–ChilcotinLillooetRevelstokeCastlegarKeremeosKimberleyPentictonSummerlandSouth OkanaganSalmon ArmMerrittCentral OkanaganCrestonGoldenKettle ValleyNelson100 Mile HouseSouth CaribooNorth ThompsonVernonGrand ForksArmstrongEnderbyArrow LakesFort NelsonNechakoKitimatPeace River NorthPeace River SouthPrince GeorgeTerraceQuesnelSmithersPrince RupertBurns LakeAgassiz–HarrisonLangleyMaple RidgeChilliwackAbbotsfordHopeDeltaNew WestminsterCoquitlamMissionSurreySouth Surrey–White RockBurnabyVan. Downtown EastsidePowell RiverVancouver City CentreSunshine CoastVancouver WestsideWest Van.–Bowen IslandNorth VancouverVancouver MidtownHowe SoundVancouver North EastRichmondVancouver South23%6%3%3%3%2%1%1%1%0%0%-1%-6%7%4%3%0%0%0%-1%-2%-4%-5%-6%-7%19%6%2%6%0%12%-3%0%-5%2%-8%-2%-11%7%8%6%-3%-4%-10%-3%-11%-9%-16%-8%-15%6%0%0%0%-2%-4%-1%1%0%3%-1%-4%-2%20%0%3%5%2%3%0%2%0%-2%-3%-2%18%3%2%1%2%0%1%0%0%2%1%-1%-5%2%1%0%0%-2%0%-1%-1%-3%-3%-4%-5%4%4%3%3%3%2%2%2%1%0%0%-1%-3%13%11%9%7%6%5%5%5%5%4%4%4%4%3%3%3%2%1%1%1%0%0%0%0%-1%-1%-1%-2%-2%-5%16%9%9%8%7%5%5%3%3%0%0%9%4%3%5%7%5%6%6%4%0%4%-1%1%12%22%11%11%11%8%5%13%4%6%16%3%9%5%2%3%0%2%0%0%0%2%5%5%4%-1%0%-5%0%-6%7%13%15%13%13%9%9%14%0%3%13%2%2%2%0%1%0%-1%-1%0%0%2%-1%-3%10%6%5%5%3%2%2%0%1%2%0%0%1%1%1%0%0%0%0%0%-5%-1%1%0%-4%-1%0%-1%-3%-5%12%7%3%6%5%3%2%1%0%3%5%-9%0%-2%0%-3%3%3%0%0%-4%0%0%-2%0%3%-1%-3%-2%0%-3%0%0%0%-4%0%3%4%5%12%4%1%0%-3%0%0%-5%-6%0%1%-10%0%3%-4%0%-9%4%-10%-8%-4%-2%-6%-2%-4%-8%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h3 72.1AntihypertensivesCardiovascular drugst h e  B C  r x  a t l a s ,  2 n d  e d i t i o n3 8Introductionfigure 2.1d» Spending per capita in BC, by age group and source of finance, 2006figure 2.1B» Percentage of spending within category by specific drug types, 2006Others 58%Diltiazem 6%Amlodipine 11%Ramipril 25%Total drug spendingper capitaSpending per capita on antihypertensives$68 $410OthersDiltiazemAmlodipineRamipril58%6%11%25%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered25%9%66%figure 2.1a» Spending within category relative to spending on all prescription drugs, 20062.1 Cardiovascular: AntihypertensivesNumberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$400$300$200$1000-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population800600400200$0.07 $0.47 $1.47 $6.46$25.63$81.89$180.99$299.10$316.0534%66%41%59%63%37%79%21%80%20%70% private;30% public62% private;38% public76% private;24% public71% private;29% public76% private;24% public79% private;21% public72% private;28% public81% private;19% publicPrivate spendingPublic spending0 3 102882207390568 57728%72%37%63%66%34%83%17%84%16%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyOthers 58%Diltiazem 6%Amlodipine 11%Ramipril 25%Total drug spendingper capitaSpending per capita on antihypertensives$68 $410OthersDiltiazemAmlodipineRamipril58%6%11%25%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered25%9%66%Total spending in BC: $268-millionSpending per capita in BC: $68.08Dispensing fees as percent of spending: 16%Users of treatment per 1,000 pop. in BC: 149Spending per user of treatment in BC: $455.90Days of treatment per user in BC: 507Cost of treatment per day in BC: $0.90Common goal of therapyReduce the risk of heart attack and stroke• Examples of indicated conditionsHigh blood pressure• Coronary artery disease• Diabetes mellitus• figure 2.1C» Percentage of drug types within category covered by BC PharmaCare, 2006U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h3 9figure 2.1e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $268 million, or $68.08 per capita, on antihypertensive drugs in 2006.This was the largest therapeutic category studied in terms of spending per capita and the second largest (after antibiotics) in terms of the number of residents filling at least one prescription. Users received an average of 506 days of hypertension treatment (more than any other category) because patients often use more than one type of antihyperten-sive drug concurrently.Leading drugs in classThe ACE-inhibitor ramipril accounted for 25% of total spending in this therapeutic category, and the calcium channel blockers amlodipine and diltiazem accounted for 11% and 6% respectively.Many other antihypertensives—including commonly used ones, such as diuretics—made up the remaining 58% of spending in this category, but no single drug accounted for more than 5%.Provincial formulary coverageBC PharmaCare provided coverage for 51 of the 56 types of antihypertensive drug sold in Canada in 2006.Spending and use by ageAntihypertensive spending and use was relatively highly concentrated among older populations. Spending per resident aged 70 and older exceeded $300 per capita, approximately two-thirds of which was funded publicly through BC PharmaCare. Spending among residents aged 50–59 and 60–69 was much lower and less fully publicly subsidized.One in five BC residents aged 50–59 purchased at least one antihypertensive drug in 2006. The rate of use grew to nearly three in five persons aged 70 and older.Most users of antihypertensive drugs aged 70 and older had at least half of their related drug costs publicly covered, whereas a majority of those under age 70 financed most of their drug costs through private means (insurance and out of pocket).Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$400$300$200$1000-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population800600400200$0.07 $0.47 $1.47 $6.46$25.63$81.89$180.99$299.10$316.0534%66%41%59%63%37%79%21%80%20%70% private;30% public62% private;38% public76% private;24% public71% private;29% public76% private;24% public79% private;21% public72% private;28% public81% private;19% publicPrivate spendingPublic spending0 3 102882207390568 57728%72%37%63%66%34%83%17%84%16%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n4 0Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 2.1a» Variation in spending per capita by local health area, 20062.1 Cardiovascular: AntihypertensivesRegional variations in spending per capitaAlthough there were notable outliers, after we accounted for differences in population age, sex, and health status, regional variation in spending per capita on antihypertensive drugs in BC in 2006 was the second lowest of all therapeutic categories studied (second to oral diabetes treatments).In 55 LHAs, antihypertensive spending per capita was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status. Spending in many Northern LHAs and several Interior LHAs was well above levels predicted based on provincial averages.Island NorthNanaimoGulf IslandsAlberniLadysmithCampbell RiverCowichanSookeGreater VictoriaSaanichLake CowichanCourtenayQualicumPrincetonGoldenLillooetCariboo–ChilcotinNelsonGrand ForksSalmon ArmCranbrookKimberleyWindermereCrestonKootenay LakeCastlegarArrow LakesTrailKettle ValleySouth OkanaganPentictonKeremeosRevelstokeKamloopsNorth ThompsonSouth CaribooMerrittSummerlandEnderby100 Mile HouseCentral OkanaganArmstrongVernonNechakoKitimatPeace River NorthBurns LakePrince GeorgePrince RupertQuesnelTerraceSmithersPeace River SouthFort Nelson$74.7$76.2$75.4$78.8$92.2$76.1$80.8$64.0$77.9$96.1$82.3$74.2$103.6$147.9$53.7$81.2$75.2$61.8$70.7$87.4$77.2$87.8$71.1$93.9$69.0$87.3$80.9$90.7$86.8$124.5$109.2$111.1$59.6$69.4$69.5$95.3$74.9$102.2$83.5$79.0$75.7$67.6$78.1$58.0$99.2$49.2$69.3$64.1$73.8$87.9$83.5$55.3$66.4$29.8$64.1$69.1$68.9$72.2$85.4$70.7$77.4$61.6$76.5$94.6$83.0$74.6$105.4$113.3$44.9$69.0$64.6$57.9$66.5$83.6$65.0$85.7$65.9$90.3$51.1$75.4$79.9$78.7$81.9$121.2$104.4$92.0$54.1$60.8$63.2$90.9$76.6$94.7$86.4$80.1$76.8$69.2$80.1$43.7$75.4$39.8$58.5$55.1$64.7$77.1$75.1$52.4$56.1$26.215%10%9%9%8%7%4%4%2%1%0%0%-2%27%18%16%15%7%6%4%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-1%-1%-2%-3%28%27%21%17%15%13%13%10%6%0%0%LangleyMissionAbbotsfordHopeChilliwackNew WestminsterBurnabyMaple RidgeAgassiz–HarrisonDeltaCoquitlamSurreySouth Surrey–White RockSunshine CoastRichmondNorth VancouverPowell RiverHowe SoundVan. Downtown EastsideVancouver MidtownVancouver SouthVancouver City CentreVancouver WestsideVancouver North EastWest Van.–Bowen Island$66.6$63.6$71.3$91.5$74.3$66.3$61.6$61.7$81.2$64.3$54.0$57.5$82.9$77.9$61.9$59.5$92.0$35.8$62.0$55.6$65.5$50.7$51.2$63.2$70.9$61.2$60.2$68.5$81.4$70.3$67.5$66.1$62.0$57.4$65.0$54.9$58.7$85.7$74.7$62.5$62.0$85.0$38.2$62.0$58.3$69.1$51.7$53.6$67.4$77.49%5%4%0%0%0%0%0%0%-1%-2%-2%-3%4%0%0%0%0%0%0%0%-2%-5%-6%-9%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h4 1Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.1f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson4152-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%355Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita4152355Users per 1,0005325838Days per user122641Cost per day64681t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n4 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 2.1B» Variation in users of treatment per 1,000 residents by local health area, 20062.1 Cardiovascular: AntihypertensivesRegional variations in rate of useAs with spending per capita in this category, there was relatively little variation across BC’s LHAs in the rate of use of antihypertensive drugs in 2006 after we accounted for differences in population age, sex, and health status.With the exception of Powell River and Sunshine Coast, the number of users of antihypertensives in Vancouver Coastal LHAs was lower than predicted based on provincial averages for populations of the same age, sex, and health status.The rates of antihypertensive use in many Northern and Interior LHAs were above rates predicted based on provincial averages.Island NorthGulf IslandsNanaimoAlberniLadysmithCampbell RiverCowichanSookeSaanichLake CowichanGreater VictoriaCourtenayQualicumKootenay LakePrincetonKeremeosCranbrookGoldenCastlegarTrailLillooetCariboo–ChilcotinKamloopsRevelstokeGrand ForksNorth ThompsonSummerlandWindermereCrestonNelsonPentictonSalmon ArmKimberleyArrow LakesKettle ValleySouth OkanaganSouth Cariboo100 Mile HouseArmstrongCentral OkanaganVernonMerrittEnderbyNechakoKitimatPeace River NorthBurns LakePeace River SouthPrince RupertFort NelsonPrince GeorgeQuesnelTerraceSmithers14518116918220615717113819918116416122515525824516311718619616015615713617614320014520013321317017318717924419918815916517617617513817910816814517377138172166116131165155168192152168137201184166164231119206206141103164173142139141126165135189139193129207166172187174243195189163169181181183105146901421261526812215615511410%9%8%8%7%4%2%0%0%0%-1%-2%-3%26%22%17%14%13%13%12%12%11%11%7%7%6%6%5%3%3%3%2%0%0%0%0%0%0%0%-3%-3%-3%-5%27%20%18%17%14%13%13%12%10%7%0%Agassiz–HarrisonHopeLangleyChilliwackMissionAbbotsfordMaple RidgeDeltaNew WestminsterSurreySouth Surrey–White RockCoquitlamBurnabyPowell RiverSunshine CoastVan. Downtown EastsideRichmondVancouver City CentreNorth VancouverVancouver WestsideVancouver MidtownVancouver SouthVancouver North EastHowe SoundWest Van.–Bowen Island179199144159136150141146150131189124137189175135139116133117125145141841601291801361531321471441491541351961291501781681381431201401241341561539217533%10%6%4%3%2%-2%-2%-3%-3%-3%-3%-9%6%4%-2%-3%-3%-6%-6%-6%-7%-8%-9%-9%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h4 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.1h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson5325838 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita4152355Users per 1,0005325838Days per user122641Cost per day64681t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n4 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 2.1C» Variation in days of treatment per user by local health area, 20062.1 Cardiovascular: AntihypertensivesRegional variations in days of treatmentAlthough averages were high across the province, after we accounted for differences in population age, sex, and health status, there was relatively little regional variation in the number of days of treatment received per user of antihypertensives in BC in 2006.In 64 LHAs, average days of treatment received per user of antihypertensives was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.The average days of antihypertensive treatment received per user in Northern LHAs was generally above levels predicted based on provincial averages.Island NorthAlberniCampbell RiverSookeSaanichCowichanNanaimoLadysmithLake CowichanGreater VictoriaCourtenayQualicumGulf IslandsLillooetPrincetonNorth ThompsonSummerlandCranbrookCariboo–ChilcotinKimberleyRevelstokeTrailPentictonCastlegarNelsonCentral OkanaganSouth OkanaganKootenay LakeKeremeosGoldenKamloopsGrand ForksWindermereCrestonSalmon ArmArrow LakesKettle ValleySouth Cariboo100 Mile HouseArmstrongVernonEnderbyMerrittKitimatQuesnelTerracePeace River SouthPeace River NorthPrince GeorgeNechakoSmithersBurns LakePrince RupertFort Nelson5085245215105325195145144915125175234905585445525565325165565245285495225255315425115235004975185205285155215295235015125245204665605535495355055114985024805014024875065044955195085045145085105125305035014985065184984865254995035245025075215334955064854955075075255185225175165125185205275004805004984864694814744824904894274%3%3%3%2%2%2%0%0%0%0%-1%-3%11%9%9%7%6%6%6%5%5%5%4%3%2%2%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-7%16%10%10%10%7%6%5%4%0%0%0%Agassiz–HarrisonHopeChilliwackMissionLangleyAbbotsfordSouth Surrey–White RockDeltaMaple RidgeCoquitlamNew WestminsterSurreyBurnabyPowell RiverSunshine CoastRichmondVancouver City CentreNorth VancouverVancouver WestsideHowe SoundWest Van.–Bowen IslandVan. Downtown EastsideVancouver SouthVancouver MidtownVancouver North East5125255335135175105164964894844934774905345035044895045034844994824914824914875005134965025115215045004985105005175125085054875035024875185065165075215%5%4%3%3%0%-1%-2%-2%-3%-3%-5%-5%4%0%0%0%0%0%0%-4%-5%-5%-5%-6%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h4 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.1i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson122-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%641Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita4152355Users per 1,0005325838Days per user122641Cost per day64681t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n4 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 2.1d» Variation in cost of treatment per day by local health area, 20062.1 Cardiovascular: AntihypertensivesRegional variations in cost per dayAlthough average costs per day were among the lowest of all therapeutic categories studied, there was relatively little regional variation in the costs per day of hypertension treatment received in BC in 2006.In 64 LHAs, costs per day of hypertension treat-ment were either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status. The costs per day of hyperten-sion treatment in several Interior LHAs were below levels predicted based on provincial averages.Supplemental data (available online) show that variations in dispensing fees per day of hypertension treatment were nearly as great as variations in the costs of drugs themselves.Island NorthLake CowichanCampbell RiverGreater VictoriaSookeCowichanSaanichCourtenayNanaimoQualicumLadysmithGulf IslandsAlberniPrincetonSalmon ArmWindermereCariboo–ChilcotinSouth OkanaganPentictonSummerlandKimberleyCranbrookCrestonKootenay LakeCastlegarKettle ValleyKeremeosGoldenKamloopsNorth ThompsonLillooetSouth CaribooMerrittEnderbyNelsonTrailCentral OkanaganRevelstokeVernonArrow Lakes100 Mile HouseArmstrongGrand ForksFort NelsonKitimatSmithersQuesnelTerracePrince GeorgePeace River NorthPeace River SouthNechakoBurns LakePrince Rupert$1.02$0.93$0.93$0.93$0.91$0.91$0.91$0.89$0.88$0.88$0.87$0.85$0.83$1.05$1.00$0.94$0.94$0.94$0.94$0.92$0.91$0.89$0.89$0.87$0.90$0.92$0.87$0.92$0.89$0.88$0.91$0.91$0.91$0.92$0.88$0.88$0.87$0.84$0.85$0.83$0.84$0.83$0.77$0.96$0.99$0.95$0.92$0.92$0.91$0.90$0.86$0.84$0.86$0.85$0.89$0.90$0.90$0.90$0.89$0.90$0.90$0.90$0.90$0.90$0.89$0.88$0.89$0.89$0.90$0.88$0.89$0.90$0.90$0.89$0.89$0.88$0.89$0.87$0.89$0.90$0.88$0.89$0.89$0.89$0.90$0.89$0.90$0.91$0.90$0.90$0.90$0.89$0.90$0.89$0.90$0.90$0.88$0.86$0.90$0.89$0.89$0.90$0.89$0.89$0.89$0.88$0.89$0.8914%3%3%3%2%1%1%0%-2%-2%-3%-4%-8%17%11%7%5%4%4%3%3%0%0%0%0%0%0%0%0%0%0%0%0%0%-2%-2%-4%-6%-7%-7%-7%-8%-13%11%9%7%3%2%2%0%-3%-4%-4%-4%AbbotsfordSurreyBurnabyHopeLangleyNew WestminsterMaple RidgeCoquitlamMissionAgassiz–HarrisonDeltaChilliwackSouth Surrey–White RockVan. Downtown EastsideVancouver MidtownNorth VancouverSunshine CoastPowell RiverHowe SoundVancouver City CentreVancouver North EastVancouver SouthWest Van.–Bowen IslandRichmondVancouver Westside$0.93$0.92$0.92$0.87$0.90$0.90$0.90$0.90$0.91$0.88$0.89$0.88$0.85$0.95$0.92$0.89$0.89$0.91$0.88$0.90$0.91$0.92$0.89$0.88$0.87$0.91$0.91$0.91$0.88$0.90$0.91$0.90$0.89$0.90$0.87$0.90$0.90$0.90$0.92$0.91$0.90$0.89$0.90$0.89$0.90$0.91$0.91$0.90$0.90$0.903%2%1%0%0%0%0%0%0%0%-1%-3%-6%4%1%0%0%0%0%0%0%0%-2%-2%-3%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h4 7Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.1J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson6468-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%1Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita4152355Users per 1,0005325838Days per user122641Cost per day64681t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n4 8Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 2.1e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20062.1 Cardiovascular: AntihypertensivesSources of spending deviationAfter we accounted for differences in population age, sex, and health status, variations across BC’s LHAs in spending per capita on antihypertensive drugs in 2006 tended to result from the combined effects of varia-tions in prescription users per 1,000 residents and days of treatment received per user.Island NorthNanaimoGulf IslandsAlberniLadysmithCampbell RiverCowichanSookeGreater VictoriaSaanichLake CowichanCourtenayQualicumPrincetonGoldenLillooetCariboo–ChilcotinNelsonGrand ForksSalmon ArmWindermereSouth OkanaganNorth ThompsonSummerlandCranbrookKimberleyPentictonCastlegarKootenay LakeKeremeosKamloopsCrestonKettle ValleySouth CaribooEnderbyMerrittTrailArrow LakesRevelstoke100 Mile HouseCentral OkanaganArmstrongVernonNechakoKitimatPeace River NorthBurns LakePrince GeorgePrince RupertQuesnelTerraceSmithersFort NelsonPeace River SouthLangleyMissionAbbotsfordAgassiz–HarrisonHopeMaple RidgeNew WestminsterBurnabyChilliwackDeltaCoquitlamSurreySouth Surrey–White RockSunshine CoastVan. Downtown EastsideVancouver MidtownPowell RiverNorth VancouverHowe SoundVancouver SouthRichmondVancouver City CentreVancouver WestsideVancouver North EastWest Van.–Bowen Island9%5%4%0%0%0%0%0%0%-1%-2%-2%-3%4%0%0%0%0%0%0%0%-2%-5%-6%-9%3%3%0%5%5%-2%-3%-5%4%-2%-3%-5%-1%0%-5%-5%4%0%0%-5%0%0%0%-6%-4%0%0%3%0%0%0%0%1%-3%-1%0%2%-6%0%4%1%0%0%0%0%-2%0%-3%0%-2%6%3%2%33%10%-2%-3%-9%4%-2%-3%-3%-3%4%-2%-6%6%-6%-9%-7%-3%-3%-6%-8%-9%15%10%9%9%8%7%4%4%2%1%0%0%-2%27%18%16%15%7%6%4%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-1%-1%-2%-3%28%27%21%17%15%13%13%10%6%0%0%4%2%-3%3%0%3%2%3%0%2%0%0%-1%9%0%11%6%3%0%0%0%2%9%7%6%6%5%4%0%0%0%0%0%0%0%-7%5%0%5%0%2%0%0%5%16%7%0%6%0%10%10%4%0%10%10%8%9%8%7%4%2%0%-1%0%0%-2%-3%22%13%12%11%3%7%2%5%0%6%6%14%0%3%13%26%17%11%3%0%0%-5%-3%12%0%7%0%-3%0%-3%27%20%18%17%12%13%10%7%0%13%14%14%-2%-4%-8%-3%3%1%2%3%1%3%0%-2%17%0%0%5%-2%-13%11%7%4%0%3%0%3%4%0%0%0%0%0%0%0%0%0%-2%-7%-6%-7%-4%-8%-7%-4%9%0%-4%2%-4%3%2%7%11%-3%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h4 92.2StatinsCardiovascular drugst h e  B C  r x  a t l a s ,  2 n d  e d i t i o n5 0Introductionfigure 2.2d» Spending per capita in BC, by age group and source of finance, 2006figure 2.2B» Percentage of spending within category by specific drug types, 2006figure 2.2a» Spending within category relative to spending on all prescription drugs, 2006Others 7%Rosuvastatin 10%Simvastatin 17%Atorvastatin 66%Total drug spendingper capitaSpending per capita on statins$38 $410OthersRosuvastatinSimvastatinAtorvastatin7%10%17%66%Unrestricted coverageListing status as of December 2006Not covered25%75%2.2 Cardiovascular: StatinsCommon goal of therapyReduce the risk of heart attack and stroke• Examples of indicated conditionsElevated cholesterol• Coronary artery disease• Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$200$150$100$500-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population400300200100$0.00 $0.04 $0.37 $2.91$14.66$52.39$118.37$175.09$116.4631%69%37%63%59%41%76%24%75%25%69% private;31% public53% private;47% public57% private;43% public76% private;24% public59% private;41% public68% private;32% publicPrivate spendingPublic spending0 0 1 73310422031120524%76%31%69%59%41%78%22%79%21%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyOthers 7%Rosuvastatin 10%Simvastatin 17%Atorvastatin 66%Total drug spendingper capitaSpending per capita on statins$38 $410OthersRosuvastatinSimvastatinAtorvastatin7%10%17%66%Unrestricted coverageListing status as of December 2006Not covered25%75%Total spending in BC: $151-millionSpending per capita in BC: $38.43Dispensing fees as percent of spending: 8%Users of treatment per 1,000 pop. in BC: 72Spending per user of treatment in BC: $532.00Days of treatment per user in BC: 285Cost of treatment per day in BC: $1.87figure 2.2C» Percentage of drug types within category covered by BC PharmaCare, 2006U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h5 1figure 2.2e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $151 million, or $38.43 per capita, on statins in 2006. This was the second largest therapeutic category studied in terms of total spending. Statin users received an average of 285 days of treat-ment, indicating that many take these medicines persistently throughout the year.Leading drugs in classAtorvastatin (best known by the brand name Lipitor) accounted for 66% of total spending on statins. To put the $100 million spent on this one drug type into perspective, atorvastatin alone would have been the third largest therapeutic category studied in terms of total spending in BC.Provincial formulary coverageBC PharmaCare provided unrestricted coverage for six of the eight types of statin sold in Canada in 2006, including atorvastatin.Spending and use by ageStatins are primarily used by older adults, with average spending per capita among BC residents aged 70–79 being more than 11 times higher than spending per resident aged 40–49.The age gradient in spending per capita was driven largely by differences in use. Whereas only 7.2% of the entire BC population filled a prescription for a statin, nearly one in three residents aged 70–79 filled one.About 35% of statin costs for residents aged 40–49 and 50–59 were publicly funded through BC PharmaCare, whereas about two-thirds of the spending on statins for persons aged 70 and older was publicly funded. Moreover, more than two-thirds of statin users aged 70 and older received public coverage for at least half of the costs of their statin prescriptions. Only about one in four statin users aged 40–49 and 50–59 received public subsidy for at least half of these medicine costs.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$200$150$100$500-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population400300200100$0.00 $0.04 $0.37 $2.91$14.66$52.39$118.37$175.09$116.4631%69%37%63%59%41%76%24%75%25%69% private;31% public53% private;47% public57% private;43% public76% private;24% public59% private;41% public68% private;32% publicPrivate spendingPublic spending0 0 1 73310422031120524%76%31%69%59%41%78%22%79%21%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n5 2Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 2.2a» Variation in spending per capita by local health area, 20062.2 Cardiovascular: StatinsRegional variations in spending per capitaAfter we accounted for differences in population age, sex, and health status, variations in statin spending across BC’s LHAs were moderate in 2006.In 46 LHAs, statin spending per capita was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Statin spending per capita in most Vancouver Coastal LHAs was below levels predicted based on provincial averages.Statin spending in Fraser LHAs was generally above levels predicted based on provincial averages. Statin spending was most varied across Interior LHAs.SookeSaanichGreater VictoriaGulf IslandsCowichanLake CowichanLadysmithAlberniCourtenayCampbell RiverIsland NorthNanaimoQualicumPrincetonSouth OkanaganPentictonKamloopsKeremeosWindermereCrestonKootenay LakeNelsonCastlegarGrand ForksKettle ValleyGoldenVernonNorth ThompsonCariboo–ChilcotinLillooetSouth CaribooMerrittEnderbySummerland100 Mile HouseCranbrookSalmon ArmKimberleyRevelstokeCentral OkanaganTrailArmstrongArrow LakesQuesnelPrince GeorgeBurns LakeTerracePrince RupertSmithersNechakoPeace River SouthPeace River NorthKitimatFort Nelson11%10%0%0%0%0%0%0%0%0%0%-1%-12%25%12%12%7%7%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-6%-9%-9%-9%-10%-12%-14%-21%-29%21%17%15%7%0%0%0%0%0%0%0%MissionAgassiz–HarrisonAbbotsfordSurreyHopeMaple RidgeChilliwackLangleyDeltaNew WestminsterCoquitlamBurnabySouth Surrey–White RockRichmondVancouver SouthWest Van.–Bowen IslandHowe SoundVancouver WestsidePowell RiverVancouver MidtownVancouver North EastNorth VancouverSunshine CoastVan. Downtown EastsideVancouver City Centre$39.9$53.7$41.8$35.8$66.1$38.3$45.6$38.9$38.9$40.0$32.0$35.5$49.3$35.1$35.1$40.7$21.8$28.4$58.1$29.1$33.0$33.6$42.0$31.5$28.9$32.5$43.7$35.2$30.8$58.5$35.1$41.8$37.5$37.1$39.6$32.5$37.2$52.0$32.6$34.9$49.1$23.4$33.7$58.3$30.0$34.0$36.4$48.5$36.6$33.921%21%17%15%12%9%9%3%0%0%0%-5%-5%7%0%0%0%0%0%-3%-3%-8%-14%-15%-16%$37.3$60.4$40.8$47.2$44.8$41.9$50.3$43.3$44.2$43.6$33.0$44.1$64.3$83.7$73.1$61.4$40.8$59.5$39.4$39.2$32.8$27.7$33.9$30.4$45.1$23.1$39.5$27.2$38.3$33.0$46.1$45.8$45.2$51.8$48.2$40.2$45.7$41.3$31.6$40.6$35.8$34.5$36.4$44.6$36.7$44.5$40.8$41.7$25.4$32.8$32.1$25.0$41.6$16.2$33.4$54.5$40.7$52.1$45.3$43.2$51.9$43.7$45.9$40.0$32.8$44.5$72.2$65.0$64.6$54.4$38.1$55.6$40.2$59.0$35.7$34.2$37.9$44.0$56.2$31.4$45.0$34.2$35.0$40.0$55.5$44.2$49.8$52.0$51.3$43.8$49.8$45.1$34.9$45.7$41.2$42.4$48.9$36.0$30.9$38.2$38.2$34.1$28.8$29.3$28.9$21.4$40.2$15.1U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h5 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.2G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.2f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson61311-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%2461Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita613112461Users per 1,0009151511425Days per user277Cost per day1969t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n5 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 2.2B» Variation in users of treatment per 1,000 residents by local health area, 20062.2 Cardiovascular: StatinsRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status, there was relatively significant variation in the number of statin users per 1,000 residents across BC’s LHAs in 2006.The rate of statin use in several Vancouver Coastal LHAs was well below rates predicted based on provin-cial averages for populations of the same age, sex, and health status. Statin use was also low in many Interior LHAs. Northern LHAs—including the population centre of Prince George—had higher rates of statin use than predicted based on provincial averages.SookeSaanichCampbell RiverGreater VictoriaCowichanLake CowichanLadysmithAlberniIsland NorthNanaimoCourtenayGulf IslandsQualicumPrincetonSouth OkanaganPentictonCariboo–ChilcotinKeremeosKamloopsWindermereKootenay LakeMerrittSummerland100 Mile HouseCranbrookSalmon ArmEnderbyKimberleyCastlegarCentral OkanaganRevelstokeVernonTrailLillooetSouth CaribooArmstrongNelsonNorth ThompsonKettle ValleyArrow LakesGoldenGrand ForksCrestonQuesnelPrince RupertBurns LakePrince GeorgePeace River NorthNechakoPeace River SouthTerraceKitimatFort NelsonSmithers68108827483789579638181871141361371087111475726586908371768172627553736461846752517975445773807895694763597183294962997675848198816283859713010812097651057175718491907985918070856183757410283656410199608311065658059415754688128569%9%8%0%0%0%0%0%0%-2%-5%-11%-13%23%13%11%8%8%6%0%0%0%0%-9%-11%-11%-11%-11%-12%-13%-13%-14%-16%-20%-20%-21%-22%-24%-24%-28%-32%-37%-41%20%19%17%16%14%10%9%0%0%0%-14%MissionAgassiz–HarrisonAbbotsfordSurreyHopeMaple RidgeChilliwackDeltaLangleyNew WestminsterCoquitlamBurnabySouth Surrey–White RockRichmondVancouver SouthPowell RiverVancouver MidtownVancouver North EastHowe SoundNorth VancouverVan. Downtown EastsideSunshine CoastVancouver City CentreVancouver WestsideWest Van.–Bowen Island74958271118728074727661699470719659673961607453537461796961106677571707663739965709960684367708763649019%19%18%16%11%8%7%4%2%0%-3%-5%-5%8%0%0%-2%-3%-9%-9%-15%-16%-18%-18%-19%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h5 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.2G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.2h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson9151511425 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita613112461Users per 1,0009151511425Days per user277Cost per day1969t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n5 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 2.2C» Variation in days of treatment per user by local health area, 20062.2 Cardiovascular: StatinsRegional variations in days of treatmentWhile averages were high across the province, after we accounted for differences in population age, sex, and health status, there was almost no variation across BC’s LHAs in the number of days of statin treatment received per statin user in 2006. Variation in the number of days of therapy per user in this therapeutic category was the smallest of all categories studied. In 77 LHAs, average days of treatment received per statin user was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.SookeQualicumCampbell RiverSaanichGreater VictoriaCowichanNanaimoLake CowichanLadysmithAlberniCourtenayGulf IslandsIsland NorthRevelstoke100 Mile HouseTrailPrincetonCranbrookNelsonCentral OkanaganVernonKamloopsPentictonKeremeosWindermereKootenay LakeMerrittSummerlandSalmon ArmEnderbyKimberleyCastlegarLillooetSouth CaribooArmstrongNorth ThompsonKettle ValleyGoldenGrand ForksCariboo–ChilcotinCrestonSouth OkanaganArrow LakesTerraceQuesnelPrince RupertPrince GeorgeNechakoPeace River SouthKitimatFort NelsonSmithersPeace River NorthBurns LakeChilliwackMaple RidgeCoquitlamLangleySouth Surrey–White RockMissionAgassiz–HarrisonHopeDeltaNew WestminsterBurnabyAbbotsfordSurreyPowell RiverVancouver WestsideVancouver City CentreNorth VancouverHowe SoundVan. Downtown EastsideSunshine CoastWest Van.–Bowen IslandRichmondVancouver North EastVancouver MidtownVancouver South2922982892952932922902892902822902812643003003012972932942952912892922862812842872952942903012892732962782792842912912802802802772952852792802772812652672802702592832902832902882872862872892852872932802872872882882862882902862852902932892912852932912872922902862872842872892812912862902902882792842822792812842712702792762793%3%2%2%2%2%2%0%0%0%0%-4%-6%5%4%4%3%2%2%2%2%1%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-2%-4%-4%-4%5%0%0%0%0%0%0%0%0%-2%-7%2942882852892912862882852822842822752653012932882892782842852922812782732742852802812862882822912822832832842842792892882842852822852892902832852822843%3%1%1%1%0%0%0%0%0%0%-3%-5%4%2%2%1%0%0%0%0%-1%-2%-3%-3%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h5 7Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.2G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.2i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson2-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%77Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita613112461Users per 1,0009151511425Days per user277Cost per day1969t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n5 8Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 2.2d» Variation in cost of treatment per day by local health area, 20062.2 Cardiovascular: StatinsRegional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, there was very little variation across BC’s LHAs in the cost of statin treatment received in 2006. Variation in this therapeutic category was among the lowest of all categories studied.In 69 LHAs, the cost per day of statin treatment received was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Costs per day of statin treatment in Powell River, Howe Sound, and Sunshine Coast were above levels predicted based on provincial averages.Island NorthGulf IslandsAlberniSaanichQualicumCourtenayGreater VictoriaSookeCowichanLake CowichanNanaimoCampbell RiverLadysmithPrincetonSalmon ArmKettle ValleyLillooetRevelstokeSummerlandPenticton100 Mile HouseWindermereCariboo–ChilcotinCranbrookCrestonEnderbySouth OkanaganKimberleyKamloopsCastlegarTrailGrand ForksKeremeosGoldenArmstrongVernonNorth ThompsonSouth CaribooMerrittCentral OkanaganNelsonKootenay LakeArrow LakesFort NelsonQuesnelTerracePeace River NorthPeace River SouthPrince GeorgePrince RupertSmithersBurns LakeNechakoKitimat$1.99$1.93$1.94$1.89$1.89$1.89$1.88$1.87$1.86$1.86$1.88$1.84$1.83$2.08$2.04$2.00$1.99$1.98$1.96$1.95$1.94$1.93$1.93$1.93$1.93$1.91$1.91$1.91$1.88$1.90$1.86$1.82$1.83$1.82$1.84$1.87$1.93$1.86$1.86$1.85$1.81$1.78$1.76$2.10$1.96$1.96$1.96$1.93$1.90$1.91$1.85$1.81$1.90$1.88$1.88$1.85$1.87$1.86$1.86$1.87$1.87$1.87$1.87$1.87$1.87$1.87$1.87$1.87$1.87$1.86$1.86$1.87$1.86$1.86$1.87$1.87$1.88$1.87$1.87$1.86$1.86$1.86$1.87$1.87$1.87$1.87$1.87$1.88$1.86$1.87$1.88$1.87$1.86$1.87$1.86$1.86$1.88$1.88$1.87$1.87$1.88$1.86$1.87$1.87$1.87$1.85$1.86$1.866%4%4%2%1%1%1%0%0%0%0%-1%-2%11%9%7%7%5%5%4%4%3%3%3%3%3%3%2%1%0%0%0%0%0%0%0%0%0%0%-1%-3%-5%-6%11%5%4%4%3%1%0%0%0%0%0%Agassiz–HarrisonHopeChilliwackMissionSurreyAbbotsfordLangleyDeltaNew WestminsterMaple RidgeCoquitlamBurnabySouth Surrey–White RockPowell RiverHowe SoundSunshine CoastNorth VancouverVancouver City CentreWest Van.–Bowen IslandVan. Downtown EastsideVancouver WestsideVancouver MidtownVancouver SouthVancouver North EastRichmond$1.96$1.96$1.93$1.90$1.90$1.86$1.87$1.87$1.85$1.84$1.84$1.82$1.80$2.01$1.99$1.98$1.91$1.90$1.89$1.85$1.83$1.82$1.79$1.78$1.77$1.86$1.86$1.86$1.87$1.88$1.87$1.88$1.87$1.87$1.87$1.87$1.87$1.87$1.87$1.88$1.87$1.87$1.87$1.87$1.87$1.87$1.87$1.87$1.86$1.865%5%4%2%1%0%0%0%-1%-2%-2%-3%-3%7%6%6%2%2%1%-1%-2%-3%-4%-5%-5%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h5 9Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.2G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.2J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%1969Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita613112461Users per 1,0009151511425Days per user277Cost per day1969t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n6 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 2.2e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20062.2 Cardiovascular: StatinsSources of spending deviationAfter we accounted for differences in population age, sex, and health status, regional variations in spending per capita on statins in BC in 2006 resulted primar-ily from variations in the number of users per 1,000 residents among LHAs.Some LHAs where use differed significantly from rates predicted based on provincial averages for popula-tions of the same age, sex, and health status did not have statistically significant differences in spending on statins. This is largely because our methods for estimating spending per capita involve an adjustment for selection bias that reduces confidence intervals for estimates from that model.SookeSaanichGreater VictoriaIsland NorthGulf IslandsAlberniCowichanLake CowichanLadysmithCourtenayCampbell RiverNanaimoQualicumPrincetonSouth OkanaganPentictonKamloopsKeremeosLillooetKettle ValleyCastlegarCrestonWindermereCariboo–ChilcotinVernonKootenay LakeMerrittEnderbySouth CaribooNorth ThompsonGoldenGrand ForksNelsonSummerland100 Mile HouseCranbrookSalmon ArmKimberleyRevelstokeCentral OkanaganTrailArmstrongArrow LakesQuesnelPrince GeorgeBurns LakeTerraceFort NelsonPeace River NorthPeace River SouthPrince RupertNechakoKitimatSmithersMissionAgassiz–HarrisonAbbotsfordSurreyHopeMaple RidgeChilliwackLangleyDeltaNew WestminsterCoquitlamBurnabySouth Surrey–White RockRichmondVancouver SouthHowe SoundWest Van.–Bowen IslandVancouver WestsidePowell RiverVancouver MidtownVancouver North EastNorth VancouverSunshine CoastVan. Downtown EastsideVancouver City Centre21%21%17%15%12%9%9%3%0%0%0%-5%-5%7%0%0%0%0%0%-3%-3%-8%-14%-15%-16%0%0%-3%-5%0%3%3%1%0%0%1%0%1%-1%-3%0%0%2%4%-3%-2%1%0%0%2%2%5%0%1%5%-2%4%0%0%-1%-2%-3%-3%-5%-4%6%1%-2%7%-3%-5%2%6%-1%2%19%19%18%16%11%8%7%2%4%0%-3%-5%-5%8%0%-9%-19%-18%0%-2%-3%-9%-16%-15%-18%11%10%0%0%0%0%0%0%0%0%0%-1%-12%25%12%12%7%7%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-6%-9%-9%-9%-10%-12%-14%-21%-29%21%17%15%7%0%0%0%0%0%0%0%3%2%2%-6%-4%0%2%0%0%0%2%2%3%3%-4%0%1%0%0%0%0%-4%0%-2%2%0%0%0%0%0%0%0%2%0%4%2%0%0%5%2%4%0%-4%0%0%-7%5%0%-2%0%0%0%0%0%9%9%0%0%-11%0%0%0%0%-5%8%-2%-13%23%13%11%6%8%-20%-24%-12%-41%0%8%-14%0%0%-11%-20%-24%-32%-37%-22%0%-9%-11%-11%-11%-13%-13%-16%-21%-28%20%16%17%0%0%14%9%19%10%0%-14%0%2%1%6%4%4%0%0%-2%1%-1%0%1%11%3%4%1%0%7%7%0%3%3%3%0%-5%0%3%0%0%0%0%-3%5%4%3%9%2%5%-1%0%0%-6%5%1%0%4%11%4%3%0%0%0%0%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h6 12.3AntithromboticsCardiovascular drugst h e  B C  r x  a t l a s ,  2 n d  e d i t i o n6 2Introductionfigure 2.3d» Spending per capita in BC, by age group and source of finance, 2006Others 1%Warfarin 20%Clopidogrel 79%Total drug spendingper capitaSpending per capita on antithrombotics$8 $410OthersWarfarinClopidogrel1%20%79%Unrestricted coverageListing status as of December 2006Restricted coverage40%60%figure 2.3C» Percentage of drug types within category covered by BC PharmaCare, 2006figure 2.3B» Percentage of spending within category by specific drug types, 2006figure 2.3a» Spending within category relative to spending on all prescription drugs, 20062.3 Cardiovascular: AntithromboticsCommon goal of therapyReduce the risk of heart attack and stroke• Treat and prevent blood clots• Examples of indicated conditionsDeep vein thrombosis• Stroke• Atrial fibrillation• Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$80$60$40$200-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population1601208040$0.0273% private;27% public$0.04 $0.12 $0.36 $1.55$5.36$16.57$39.17$56.8236%64%40%60%42%58%72%28%Private spendingPublic spending0 0 1 25154410514531%69%38%62%61%39%77%23%80% private;20% public66% private;34% public73% private;27% public73% private;27% public80% private;20% public67% private;33% public77% private;23% public78% private;22% public73% private;27% publicUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyOthers 1%Warfarin 20%Clopidogrel 79%Total drug spendingper capitaSpending per capita on antithrombotics$8 $410OthersWarfarinClopidogrel1%20%79%Unrestricted coverageListing status as of December 2006Restricted coverage40%60%Total spending in BC: $30-millionSpending per capita in BC: $7.72Dispensing fees as percent of spending: 16%Users of treatment per 1,000 pop. in BC: 21Spending per user of treatment in BC: $370.05Days of treatment per user in BC: 305Cost of treatment per day in BC: $1.21U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h6 3figure 2.3e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $30 million, or $7.72 per capita, on antithrombotic drugs in 2006. In terms of spending per capita, this was the 12th largest thera-peutic category studied.While only about 2% of BC’s population filled an antithrombotic prescription, users received an average of 305 days of treatment, indicating that many users take these medicines relatively persistently throughout the year.Leading drugs in classA single drug, clopidogrel, accounted for a vast majority (79%) of spending on antithrombotic drugs. Provincial formulary coverageBC PharmaCare provided some level of coverage for all five types of antithrombotic drugs sold in Canada in 2006.Spending and use by ageThe use of and spending on antithrombotic drugs in BC were highly concentrated among older adults in 2006. With little or no use of antithrombotics among resi-dents under age 50, the age gradient for this category was among the three steepest of the therapeutic categories studied.Spending on antithrombotics among the population aged 70 and older was $40 per capita, approximately 60% of which was funded publicly through BC Phar-maCare. Spending among residents in their 50s and 60s was much lower and less fully publicly subsidized. Approximately one person in 20 aged 60–69 filled at least one antithrombotic prescription in 2006, and more than one in 10 persons aged 70 and older did so.A majority of users of antithrombotic drugs aged 70 and older received public coverage for at least half of the costs of their antithrombotic prescriptions.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$80$60$40$200-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population1601208040$0.0273% private;27% public$0.04 $0.12 $0.36 $1.55$5.36$16.57$39.17$56.8236%64%40%60%42%58%72%28%Private spendingPublic spending0 0 1 25154410514531%69%38%62%61%39%77%23%80% private;20% public66% private;34% public73% private;27% public73% private;27% public80% private;20% public67% private;33% public77% private;23% public78% private;22% public73% private;27% publicUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n6 4Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 2.3a» Variation in spending per capita by local health area, 20062.3 Cardiovascular: AntithromboticsRegional variations in spending per capitaIn 2006, there were moderate variations in spending on antithrombotics across BC’s LHAs after we accounted for differences in population age, sex, and health status.In 53 LHAs, antithrombotic spending per capita was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Spending on antithrombotics in several Vancouver Island and Interior LHAs was above levels predicted based on provincial averages.Campbell RiverSookeNanaimoCourtenayCowichanGreater VictoriaSaanichGulf IslandsLake CowichanLadysmithQualicumAlberniIsland NorthKootenay LakeWindermereCentral OkanaganKimberleySalmon ArmKamloopsEnderbySummerlandRevelstokeCranbrookCrestonNelsonCastlegarTrailPentictonKeremeosPrincetonGoldenArmstrongNorth ThompsonCariboo–ChilcotinLillooetSouth CaribooSouth OkanaganMerrittGrand ForksArrow LakesKettle Valley100 Mile HouseVernonPrince RupertQuesnelTerraceSmithersBurns LakeNechakoPrince GeorgePeace River SouthPeace River NorthKitimatFort Nelson$12.8$7.6$9.7$10.4$11.8$10.3$12.9$11.6$11.7$14.1$14.7$9.4$8.8$7.4$9.4$10.4$8.4$12.4$7.3$12.8$13.7$9.2$9.3$12.2$8.9$9.7$12.4$12.9$12.1$13.1$7.3$7.9$6.6$6.4$8.8$9.9$16.2$7.0$9.2$7.2$11.7$8.2$9.3$5.8$6.0$9.1$5.1$7.1$4.8$5.7$7.2$4.0$7.3$2.2$8.3$6.2$8.0$8.8$10.2$9.0$10.7$10.9$7.6$12.5$15.2$7.7$5.5$4.9$7.8$9.0$7.3$10.9$6.5$11.5$12.8$8.7$7.4$13.8$6.7$6.9$10.1$11.6$12.2$11.2$6.3$9.5$5.6$10.4$7.1$9.1$16.8$7.3$9.6$7.6$12.5$8.7$10.9$4.5$5.1$7.6$4.8$6.3$4.0$4.7$4.4$3.0$6.2$1.343%21%19%16%14%0%0%0%0%0%0%0%0%42%18%15%14%13%11%11%6%5%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-3%-4%-4%-6%-6%-6%-15%25%18%17%0%0%0%0%0%0%0%0%AbbotsfordLangleyMissionHopeChilliwackBurnabyMaple RidgeCoquitlamAgassiz–HarrisonSurreyNew WestminsterDeltaSouth Surrey–White RockSunshine CoastNorth VancouverRichmondVancouver City CentreVan. Downtown EastsideVancouver North EastVancouver MidtownVancouver SouthHowe SoundWest Van.–Bowen IslandPowell RiverVancouver Westside$9.0$9.0$7.6$12.0$8.5$6.1$6.4$5.0$10.5$5.8$8.5$7.4$11.2$10.4$6.2$5.7$5.3$5.1$4.5$4.3$5.4$3.0$9.9$11.3$5.7$8.3$8.3$7.2$10.4$7.9$7.7$7.0$5.7$7.6$5.9$8.8$7.7$12.0$9.7$6.1$5.9$6.0$7.2$6.4$5.5$7.0$3.0$10.2$12.3$6.49%8%5%0%0%0%0%0%0%-2%-3%-4%-7%7%2%0%0%0%0%0%0%-1%-3%-9%-11%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h6 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.3f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson7107-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%253Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita7107253Users per 1,000111014113624Days per user1085713Cost per day391411546t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n6 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 2.3B» Variation in users of treatment per 1,000 residents by local health area, 20062.3 Cardiovascular: AntithromboticsRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status, there were significant regional variations in the number of antithrombotic drug users per 1,000 residents across BC’s LHAs in 2006.The rates of antithrombotic use in many Vancouver Coastal and Fraser LHAs were lower than rates predicted based on provincial averages for populations of the same age, sex, and health status.Rates of antithrombotic use in several Northern, Interior, and Vancouver Island LHAs were far higher than predicted based on provincial averages.Island NorthLake CowichanCampbell RiverNanaimoAlberniSookeSaanichCourtenayGreater VictoriaCowichanLadysmithGulf IslandsQualicumKootenay LakeCastlegarNelsonCranbrookKimberleyTrailNorth ThompsonCentral OkanaganWindermereKamloopsPentictonSalmon ArmEnderbySummerlandRevelstokeKeremeosPrincetonGoldenLillooetSouth CaribooMerrittGrand ForksArrow LakesKettle Valley100 Mile HouseSouth OkanaganCrestonVernonArmstrongCariboo–ChilcotinPeace River SouthFort NelsonPrince RupertPeace River NorthQuesnelPrince GeorgeNechakoTerraceSmithersBurns LakeKitimat22312928262035282730373241262824242632222922233330292923343319253022312725243832272319208201218161520151919152120232117292524273331431721191921271825202031272728233429172127223128292541373228311351591514131814171742%42%38%19%18%18%18%13%12%11%10%0%-4%42%31%25%23%18%18%17%15%13%12%9%9%0%0%0%0%0%0%0%0%0%0%0%0%0%-7%-15%-17%-20%-48%46%46%28%27%18%16%14%11%0%0%0%Agassiz–HarrisonHopeChilliwackLangleyAbbotsfordMissionNew WestminsterSurreyDeltaSouth Surrey–White RockMaple RidgeCoquitlamBurnabySunshine CoastNorth VancouverHowe SoundWest Van.–Bowen IslandRichmondPowell RiverVancouver WestsideVancouver City CentreVancouver MidtownVancouver SouthVancouver North EastVan. Downtown Eastside273123232219221519321714163019112915281715121412132028222221192316213419162128191129173119181619181927%12%6%5%5%0%-6%-6%-7%-8%-10%-16%-26%6%0%0%0%-7%-12%-12%-15%-26%-28%-36%-36%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h6 7Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.3h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson111014113624 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita7107253Users per 1,000111014113624Days per user1085713Cost per day391411546t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n6 8Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 2.3C» Variation in days of treatment per user by local health area, 20062.3 Cardiovascular: AntithromboticsRegional variations in days of treatmentIn contrast to the significant variations in the number of antithrombotic drug users across BC’s LHAs in 2006, there were only modest variations in the average number of days of treatment received per user after we accounted for differences in population age, sex, and health status.In 57 LHAs, average days of treatment purchased per user of antithrombotics was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.After we accounted for differences in population age, sex, and health status, the number of days of antithrombotic treatment received per user was most varied across Interior LHAs.CourtenayLadysmithIsland NorthLake CowichanCampbell RiverNanaimoAlberniSookeCowichanGulf IslandsGreater VictoriaSaanichQualicumLillooetSouth CaribooNorth ThompsonWindermerePrincetonCariboo–ChilcotinVernon100 Mile HouseCentral OkanaganKootenay LakeCastlegarNelsonCranbrookTrailKamloopsSalmon ArmEnderbySummerlandRevelstokeGoldenMerrittGrand ForksKettle ValleyCrestonArmstrongSouth OkanaganPentictonKeremeosKimberleyArrow LakesTerracePeace River SouthSmithersPrince RupertPeace River NorthQuesnelPrince GeorgeNechakoBurns LakeKitimatFort Nelson33932429831731130929830531230630530627538636136336335734833532731831129631930029930530130731131328928332334131031629528528027026532732932827829731529632333131822930431030130630230530430730831431331430730630030231531331230830130631531031130431030430930431231430430331730530931131430731430430630130630530029830429830430630428711%5%0%0%0%0%0%0%0%0%-2%-3%-11%23%18%18%14%13%11%8%8%4%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-6%-8%-11%-12%-15%8%8%7%0%0%0%0%0%0%0%-23%HopeMaple RidgeLangleyAgassiz–HarrisonAbbotsfordMissionNew WestminsterDeltaSouth Surrey–White RockCoquitlamBurnabySurreyChilliwackNorth VancouverHowe SoundWest Van.–Bowen IslandRichmondPowell RiverVancouver WestsideVancouver City CentreVancouver MidtownVancouver SouthVancouver North EastVan. Downtown EastsideSunshine Coast34530730833230530429730030329930229128430329930430632231130930929931130827030629630030930430230230330930030329730130630131230731031230730330430730131212%4%3%0%0%0%0%0%0%0%0%-2%-6%0%0%0%0%0%0%0%0%0%0%0%-14%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h6 9Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.3i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson108-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%5713Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita7107253Users per 1,000111014113624Days per user1085713Cost per day391411546t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n7 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 2.3d» Variation in cost of treatment per day by local health area, 20062.3 Cardiovascular: AntithromboticsRegional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, there was moderate varia-tion across BC’s LHAs in the average cost per day of antithrombotic treatment received in 2006. The average cost per day of antithrombotic treatment was particularly varied among Interior LHAs, where costs per day in 12 LHAs differed by more than 15% from levels predicted based on provincial averages for populations of the same age, sex, and health status.Supplemental data (available online) show that varia-tions in dispensing fees paid per day of antithrombotic treatment were less than variations in the costs of the drugs themselves.Campbell RiverCowichanQualicumSookeGreater VictoriaSaanichGulf IslandsLake CowichanLadysmithAlberniIsland NorthCourtenayNanaimoSouth OkanaganSummerlandRevelstokeSalmon ArmWindermereEnderbyCrestonPentictonCranbrookKimberleyCastlegarTrailKettle ValleyKeremeosPrincetonGoldenArmstrongCariboo–ChilcotinMerrittNelsonVernonCentral OkanaganKamloopsArrow Lakes100 Mile HouseGrand ForksLillooetKootenay LakeSouth CaribooNorth ThompsonTerraceSmithersBurns LakeKitimatFort NelsonPrince GeorgePeace River NorthPeace River SouthNechakoQuesnelPrince Rupert$1.44$1.28$1.30$1.23$1.24$1.20$1.19$1.19$1.18$1.23$1.33$1.10$1.10$1.44$1.53$1.28$1.37$1.16$1.44$1.23$1.35$1.29$1.21$1.15$1.31$1.35$1.27$1.12$1.31$1.10$0.95$1.12$1.14$1.03$1.15$1.04$1.01$1.06$0.92$0.93$0.92$0.92$0.84$1.36$1.06$1.14$1.21$1.18$1.18$1.11$1.10$0.97$1.06$1.04$1.29$1.14$1.22$1.16$1.18$1.19$1.15$1.21$1.12$1.22$1.24$1.19$1.21$1.13$1.21$1.04$1.14$0.97$1.24$1.13$1.27$1.25$1.31$1.23$1.24$1.23$1.17$1.04$1.16$1.11$0.97$1.23$1.22$1.16$1.30$1.19$1.20$1.26$1.12$1.15$1.25$1.30$1.21$1.26$1.11$1.24$1.11$1.37$1.23$1.22$1.26$1.13$1.24$1.2311%11%6%6%5%0%0%0%0%0%0%-8%-9%24%23%21%19%18%14%9%6%0%0%0%0%0%0%0%0%0%0%0%-6%-12%-12%-14%-17%-18%-19%-22%-31%-35%-37%8%0%0%0%0%-4%-10%-13%-15%-16%-17%AbbotsfordSurreyDeltaMissionBurnabyHopeChilliwackLangleyNew WestminsterCoquitlamAgassiz–HarrisonSouth Surrey–White RockMaple RidgePowell RiverSunshine CoastRichmondWest Van.–Bowen IslandVancouver City CentreVan. Downtown EastsideVancouver North EastVancouver MidtownVancouver SouthVancouver WestsideNorth VancouverHowe Sound$1.37$1.34$1.28$1.31$1.26$1.11$1.31$1.28$1.33$1.23$1.17$1.16$1.23$1.27$1.28$1.21$1.15$1.13$1.23$1.18$1.17$1.25$1.11$1.06$0.91$1.24$1.24$1.20$1.23$1.22$1.17$1.27$1.30$1.28$1.23$1.15$1.19$1.30$1.09$1.15$1.20$1.17$1.15$1.24$1.16$1.20$1.22$1.15$1.22$1.2210%8%6%6%3%0%0%0%0%0%0%0%-6%15%11%0%0%0%0%0%0%0%-4%-14%-29%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h7 1Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 2.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 2.3J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson391411-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%546Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita7107253Users per 1,000111014113624Days per user1085713Cost per day391411546t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n7 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 2.3e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20062.3 Cardiovascular: AntithromboticsSources of spending deviationRegional variations in antithrombotic spending per capita in BC in 2006 resulted almost entirely from variations in the number of users per 1,000 residents among LHAs.Some LHAs where use differed significantly from rates predicted based on provincial averages for populations of the same age, sex, and health status did not have statistically significant differences in spending. This is partly the result of offsetting impacts from days per user and costs per day; it is also partly because our methods for estimating spending per capita involve an adjustment for selection bias that reduces confidence intervals for estimates from that model.Campbell RiverSookeNanaimoCourtenayCowichanGulf IslandsGreater VictoriaLadysmithIsland NorthLake CowichanAlberniSaanichQualicumKootenay LakeWindermereCentral OkanaganKimberleySalmon ArmKamloopsEnderbySummerlandRevelstokeCrestonTrailLillooetPrincetonCariboo–ChilcotinCastlegarNelsonCranbrookGoldenArmstrongPentictonKeremeosSouth CaribooNorth ThompsonSouth OkanaganMerrittGrand ForksArrow LakesKettle Valley100 Mile HouseVernonPrince RupertQuesnelTerraceKitimatSmithersPeace River NorthPrince GeorgeNechakoBurns LakeFort NelsonPeace River SouthAbbotsfordLangleyMissionHopeMaple RidgeAgassiz–HarrisonCoquitlamBurnabyChilliwackSurreyNew WestminsterDeltaSouth Surrey–White RockSunshine CoastNorth VancouverVancouver City CentreRichmondVancouver MidtownVancouver SouthVancouver North EastVan. Downtown EastsideHowe SoundWest Van.–Bowen IslandPowell RiverVancouver Westside9%8%5%0%0%0%0%0%0%-2%-3%-4%-7%7%2%0%0%0%0%0%0%-1%-3%-9%-11%0%3%0%12%4%0%0%0%-6%-2%0%0%0%-14%0%0%0%0%0%0%0%0%0%0%0%10%0%6%0%-6%0%0%3%0%8%0%6%0%11%-14%0%0%0%0%0%0%-29%0%15%-4%5%5%0%12%-10%27%-16%-26%6%-6%-6%-7%-8%6%0%-15%-7%-26%-28%-36%-36%0%0%-12%-12%43%21%19%16%14%0%0%0%0%0%0%0%0%42%18%15%14%13%11%11%6%5%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-3%-4%-4%-6%-6%-6%-15%25%18%17%0%0%0%0%0%0%0%0%0%0%0%11%0%0%-2%5%0%0%0%-3%-11%0%14%4%-12%0%0%0%0%0%0%0%23%13%11%0%0%0%0%0%-8%-11%18%18%-6%0%0%-15%0%8%8%0%0%8%0%7%0%0%0%0%-23%8%38%18%19%13%11%0%12%10%42%42%18%18%-4%42%13%15%18%9%12%0%0%0%-15%18%0%0%-48%31%25%23%0%-20%9%0%0%17%-7%0%0%0%0%0%-17%28%18%11%0%0%27%16%14%0%46%46%11%6%-9%-8%11%0%5%0%0%0%0%0%6%-31%18%-12%0%19%-14%14%23%21%9%0%-22%0%0%0%-6%0%0%0%6%0%-35%-37%24%0%-19%-17%0%-18%-12%-17%-16%8%0%0%-10%-4%-15%0%0%-13%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h7 3Neurological drugs3.1Antidepressantst h e  B C  r x  a t l a s ,  2 n d  e d i t i o n7 4Introductionfigure 3.1d» Spending per capita in BC, by age group and source of finance, 2006figure 3.1C» Percentage of drug types within category covered by BC PharmaCare, 2006figure 3.1B» Percentage of spending within category by specific drug types, 2006figure 3.1a» Spending within category relative to spending on all prescription drugs, 2006Others 22%Sertraline 8%Fluoxetine 8%Paroxetine 12%Citalopram 16%Venlafaxine 34%Total drug spendingper capitaSpending per capita on antidepressants$35 $410OthersSertralineFluoxetineParoxetineCitalopramVenlafaxine22%8%8%12% 16%34%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered5%14%82%3.1 Neurological: AntidepressantsCommon goal of therapyReduce symptoms of clinical depression • and anxietyExamples of indicated conditionsMajor depressive disorder• Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$80$60$40$200-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population20015010050$0.2265% private;35% public69% private;31% public$5.44$21.64$36.29$49.23$58.48$50.63$42.70$49.4225%75%33%67%52%48%64%36%63%37%63%37%54%46%Private spendingPublic spending1227010312614513913415421%79%31%69%58%42%74%26%75%25%74%26%66%34%74%26%72% private;28% public72%28%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyOthers 22%Sertraline 8%Fluoxetine 8%Paroxetine 12%Citalopram 16%Venlafaxine 34%Total drug spendingper capitaSpending per capita on antidepressants$35 $410OthersSertralineFluoxetineParoxetineCitalopramVenlafaxine22%8%8%12% 16%34%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered5%14%82%Total spending in BC: $138-millionSpending per capita in BC: $35.14Dispensing fees as percent of spending: 16%Users of treatment per 1,000 pop. in BC: 97Spending per user of treatment in BC: $361.32Days of treatment per user in BC: 266Cost of treatment per day in BC: $1.36U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h7 5figure 3.1e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $138 million, or $35.14 per capita, on antidepressant drugs in 2006. In terms of spending per capita, this was the third largest thera-peutic category studied.Nearly one in 10 BC residents—and one in eight adults—filled an antidepressant prescription. On average, antidepressant users received 266 days of treatment, indicating that many are taking these medicines persistently throughout the year.Leading drugs in classVenlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), accounted for 34% of antidepressant spending, an amount approximately equal to the next three drug types in this category combined.Provincial formulary coverageBC PharmaCare provided some level of coverage for 19 of the 22 types of antidepressant drug sold in Canada in 2006.Spending and use by ageThe use of and spending on antidepressant drugs was relatively evenly spread across adult age groups. Spending and use was negligible among children under age 10, but increased rapidly through to the age groups of 40–49 and 50–59.Spending by age group peaked at $58.48 per person aged 50–59, most of which was financed through private means (insurance or out of pocket).More than one person in eight aged 30 or older filled at least one antidepressant prescription, and more than one in seven people aged 50–59 and aged 80 and older did so.PharmaCare paid for at least 50% of antidepressant costs for a significant majority of antidepressant users aged 70 and older and a minority of younger antide-pressant users.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$80$60$40$200-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population20015010050$0.2265% private;35% public69% private;31% public$5.44$21.64$36.29$49.23$58.48$50.63$42.70$49.4225%75%33%67%52%48%64%36%63%37%63%37%54%46%Private spendingPublic spending1227010312614513913415421%79%31%69%58%42%74%26%75%25%74%26%66%34%74%26%72% private;28% public72%28%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n7 6Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 3.1a» Variation in spending per capita by local health area, 20063.1 Neurological: AntidepressantsRegional variations in spending per capitaAfter we accounted for differences in population age, sex, and health status, spending on antidepressants varied significantly across BC’s LHAs in 2006.Antidepressant spending per capita in 50 LHAs was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Antidepressant spending per capita in many Van-couver Coastal LHAs was much lower than levels predicted based on provincial averages. Antidepressant spending in several Interior, Northern, and Vancouver Island LHAs was much higher than predicted.Island NorthAlberniNanaimoGreater VictoriaCourtenayLake CowichanCowichanCampbell RiverLadysmithSaanichSookeGulf IslandsQualicumCariboo–ChilcotinTrailNorth ThompsonKootenay LakeLillooetRevelstoke100 Mile HouseKamloopsSalmon ArmCrestonCastlegarCentral OkanaganNelsonGoldenArmstrongCranbrookKimberleyWindermereGrand ForksKettle ValleySouth OkanaganPentictonKeremeosPrincetonVernonSouth CaribooSummerlandEnderbyMerrittArrow LakesPeace River NorthQuesnelPrince GeorgeSmithersPeace River SouthBurns LakeFort NelsonPrince RupertNechakoKitimatTerrace$33.7$38.4$43.3$51.2$40.2$42.7$42.6$38.1$41.7$41.5$42.6$39.9$38.4$34.9$49.2$31.2$24.0$32.5$36.9$42.6$41.1$46.3$44.7$33.8$45.9$29.3$22.4$35.0$41.2$38.2$35.1$36.8$28.9$43.7$58.3$43.6$58.9$45.7$32.2$54.1$40.8$44.5$23.8$26.9$40.0$36.4$35.4$31.4$24.6$20.4$30.7$31.3$42.9$39.6$27.3$31.5$37.0$44.7$35.7$38.3$38.7$35.3$39.9$40.3$36.8$36.2$40.3$24.7$34.8$23.3$18.7$25.6$29.1$33.8$32.6$38.1$38.1$29.5$41.5$26.5$20.4$33.1$31.7$33.4$25.8$33.2$27.3$41.8$48.6$36.0$45.3$45.1$30.7$41.8$36.3$46.5$25.8$20.3$32.2$29.4$29.8$27.3$22.2$18.7$29.1$19.5$38.2$37.821%20%16%14%12%11%10%8%5%3%0%0%-5%35%35%29%25%24%24%23%23%19%16%14%10%10%9%6%0%0%0%0%0%0%0%0%0%0%0%0%0%-4%-8%28%22%21%17%14%10%9%5%0%0%0%ChilliwackLangleyMaple RidgeMissionAbbotsfordHopeDeltaNew WestminsterAgassiz–HarrisonSouth Surrey–White RockCoquitlamSurreyBurnabyVan. Downtown EastsideSunshine CoastVancouver City CentrePowell RiverNorth VancouverHowe SoundVancouver WestsideWest Van.–Bowen IslandVancouver MidtownRichmondVancouver North EastVancouver South$42.7$37.0$42.9$40.0$37.6$47.1$32.0$37.9$45.5$37.6$29.1$27.9$23.6$51.7$39.8$43.5$43.4$34.5$27.9$30.5$32.6$25.9$19.9$17.8$18.8$35.8$32.0$38.4$36.0$34.7$38.1$34.1$38.5$27.2$40.3$32.2$31.1$32.5$45.1$37.2$42.5$37.5$36.5$30.1$35.6$39.1$33.2$29.1$28.2$30.018%15%11%11%8%0%0%0%0%-7%-10%-11%-32%14%7%2%0%-6%-7%-16%-18%-25%-38%-46%-47%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h7 7Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.1f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson14196-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%42934Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita1419642934Users per 1,00018102563413Days per user713572Cost per day56111011t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n7 8Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.1B» Variation in users of treatment per 1,000 residents by local health area, 20063.1 Neurological: AntidepressantsRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status, the number of antidepressant drug users per 1,000 residents varied significantly across BC’s LHAs in 2006.With the exception of Vancouver Downtown Eastside and Sunshine Coast, use of antidepressants in Vancou-ver Coastal LHAs was far lower than predicted based on provincial averages for populations of the same age, sex, and health status.Antidepressant use in most Northern, Interior, and Vancouver Island LHAs was well above rates predicted based on provincial averages.Island NorthAlberniLake CowichanNanaimoSookeCourtenayGreater VictoriaCowichanGulf IslandsCampbell RiverSaanichLadysmithQualicumCariboo–ChilcotinTrailNorth ThompsonKootenay LakeWindermereLillooetPrinceton100 Mile HouseSummerlandCranbrookRevelstokeKamloopsKeremeosPentictonSalmon ArmCastlegarGoldenCrestonNelsonKimberleyEnderbyGrand ForksCentral OkanaganArmstrongSouth OkanaganKettle ValleyVernonSouth CaribooMerrittArrow LakesNechakoPeace River NorthQuesnelPrince GeorgeSmithersPeace River SouthBurns LakeFort NelsonKitimatPrince RupertTerrace104118134123116116127121114110114111107114140107859610815012613511110411911514111511290104971041061071211041178911998126839485116109104958875112921068495113105101103114109103102111108113809979657483115991068783959611896947792869296971119711184118941288862659388888278671018710222%21%17%16%13%12%11%10%10%8%2%0%-5%35%35%31%27%27%26%26%24%24%24%23%23%18%17%17%17%15%13%12%12%10%10%9%7%5%0%0%0%0%0%43%26%22%21%17%14%12%11%10%6%4%Agassiz–HarrisonHopeChilliwackLangleyMissionAbbotsfordMaple RidgeNew WestminsterDeltaSouth Surrey–White RockSurreyCoquitlamBurnabyPowell RiverVan. Downtown EastsideSunshine CoastVancouver City CentreHowe SoundNorth VancouverVancouver WestsideWest Van.–Bowen IslandVancouver MidtownRichmondVancouver North EastVancouver South1141251151011131121101019210685796711511710710781927991705755577210498901011011021049811593899310110510110888100951109084858946%19%17%12%11%10%8%-3%-6%-8%-9%-12%-32%13%12%5%0%-8%-8%-19%-20%-25%-38%-44%-44%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h7 9Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.1h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson18102563413 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita1419642934Users per 1,00018102563413Days per user713572Cost per day56111011t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n8 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 3.1C» Variation in days of treatment per user by local health area, 20063.1 Neurological: AntidepressantsRegional variations in days of treatmentAfter we accounted for differences in population age, sex, and health status, the average number of days of treatment received per user of antidepressants varied modestly across BC’s LHAs in 2006.In 57 LHAs, average days of treatment received per user of antidepressants was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.After we accounted for differences in population age, sex, and health status, the number of days of antide-pressant treatment received per user was most varied among Interior LHAs. This variation was nevertheless modest when compared to variation in days of treat-ment for other therapeutic categories.Greater VictoriaSaanichAlberniNanaimoSookeCourtenayCowichanGulf IslandsCampbell RiverLadysmithQualicumIsland NorthLake CowichanCrestonTrailSummerlandPentictonKamloopsCentral OkanaganSalmon ArmVernonNorth ThompsonKootenay LakeLillooetPrinceton100 Mile HouseCranbrookRevelstokeKeremeosKimberleyEnderbyGrand ForksSouth OkanaganKettle ValleyArrow LakesNelsonMerrittCastlegarWindermereArmstrongCariboo–ChilcotinSouth CaribooGoldenNechakoPrince GeorgeSmithersKitimatPrince RupertTerraceQuesnelPeace River SouthPeace River NorthBurns LakeFort Nelson2842832622702702742752772642822792472473052802912802692762752762472392552692632692622742742802732692462602522522462442492332472112522612532582472692542452342261992682742642672652702732792662742792632702692622742712602682682692602592642722672632602722732702692732662722632672622602672532712612532632592662602632652552482632446%3%0%0%0%0%0%0%0%0%0%-6%-9%12%7%6%3%3%3%3%3%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-4%-6%-6%-7%-7%-8%-9%-21%0%0%0%0%0%0%-4%-4%-6%-15%-20%Agassiz–HarrisonMaple RidgeLangleySouth Surrey–White RockHopeChilliwackNew WestminsterCoquitlamDeltaMissionAbbotsfordBurnabySurreyVancouver City CentreVancouver WestsideVan. Downtown EastsideNorth VancouverPowell RiverWest Van.–Bowen IslandVancouver MidtownRichmondSunshine CoastHowe SoundVancouver SouthVancouver North East2792782712832772702712642612572562602372832842642772652752602582632492472432622672632772712672672632672632642702632642672562692672782602682742622672647%4%3%2%0%0%0%0%-2%-2%-3%-4%-10%7%6%3%3%0%0%0%-4%-4%-5%-8%-8%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h8 1Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.1i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson713-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%572Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita1419642934Users per 1,00018102563413Days per user713572Cost per day56111011t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n8 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.1d» Variation in cost of treatment per day by local health area, 20063.1 Neurological: AntidepressantsRegional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, the cost per day of antidepressant therapy varied modestly across BC’s LHAs in 2006.Costs per day of antidepressants purchased in 61 LHAs were either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.After we accounted for differences in population age, sex, and health status, the average cost per day of antidepressant treatment was highest in Vancou-ver Downtown Eastside and most varied among Interior LHAs.Greater VictoriaSookeLake CowichanLadysmithQualicumSaanichNanaimoGulf IslandsIsland NorthCampbell RiverCowichanCourtenayAlberniPrincetonSalmon ArmWindermereCrestonPentictonKeremeosSouth OkanaganSummerlandVernonCranbrookCentral OkanaganKimberleyKootenay LakeKettle ValleyRevelstokeArmstrongCariboo–ChilcotinSouth CaribooMerrittEnderby100 Mile HouseKamloopsGrand ForksTrailCastlegarNelsonLillooetGoldenNorth ThompsonArrow LakesKitimatQuesnelPrince RupertSmithersNechakoPeace River SouthFort NelsonTerracePeace River NorthPrince GeorgeBurns Lake$1.41$1.36$1.29$1.34$1.29$1.29$1.31$1.27$1.31$1.31$1.28$1.26$1.24$1.46$1.47$1.49$1.41$1.48$1.38$1.38$1.38$1.39$1.39$1.38$1.34$1.18$1.31$1.36$1.35$1.31$1.33$1.40$1.37$1.28$1.29$1.27$1.25$1.23$1.19$1.19$1.19$1.17$1.10$1.48$1.36$1.35$1.35$1.31$1.35$1.37$1.39$1.35$1.28$1.23$1.35$1.37$1.35$1.32$1.30$1.31$1.35$1.31$1.36$1.37$1.35$1.35$1.33$1.30$1.32$1.34$1.29$1.35$1.29$1.31$1.33$1.35$1.35$1.35$1.32$1.26$1.29$1.35$1.34$1.33$1.31$1.36$1.32$1.34$1.34$1.33$1.32$1.33$1.32$1.31$1.33$1.32$1.29$1.39$1.37$1.35$1.38$1.31$1.36$1.44$1.38$1.39$1.39$1.355%0%0%0%0%-2%-3%-3%-4%-5%-5%-7%-7%12%11%11%9%9%7%6%4%3%2%2%0%0%0%0%0%0%0%0%0%-4%-4%-5%-5%-8%-10%-10%-12%-12%-16%6%0%0%0%0%0%0%0%-3%-8%-9%Agassiz–HarrisonCoquitlamHopeChilliwackLangleyNew WestminsterMaple RidgeMissionSurreyBurnabyDeltaAbbotsfordSouth Surrey–White RockVan. Downtown EastsidePowell RiverSunshine CoastVancouver MidtownVancouver City CentreRichmondWest Van.–Bowen IslandHowe SoundVancouver North EastVancouver WestsideVancouver SouthNorth Vancouver$1.43$1.40$1.36$1.37$1.35$1.38$1.40$1.37$1.38$1.35$1.33$1.31$1.25$1.66$1.42$1.42$1.43$1.43$1.35$1.31$1.39$1.34$1.37$1.34$1.35$1.29$1.38$1.34$1.37$1.35$1.37$1.40$1.40$1.38$1.36$1.36$1.36$1.32$1.39$1.32$1.34$1.39$1.39$1.36$1.32$1.41$1.36$1.36$1.36$1.3610%1%0%0%0%0%0%0%0%-1%-2%-4%-6%18%7%6%3%3%0%0%0%0%0%0%-1%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h8 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.1G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.1J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson561110-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%11Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita1419642934Users per 1,00018102563413Days per user713572Cost per day56111011t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n8 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 3.1e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20063.1 Neurological: AntidepressantsSources of spending deviationAfter we accounted for differences in population age, sex, and health status, variations across BC’s LHAs in antidepressant spending per capita in 2006 resulted almost entirely from variations in the number of users per 1,000 residents.Some LHAs where use differed significantly from rates predicted based on provincial averages for populations of the same age, sex, and health status did not have statistically significant differences in spending. This is partly the result of offsetting impacts from days per user and costs per day; it is also partly because our methods for estimating spending per capita involve an adjustment for selection bias that reduces confidence intervals for estimates from that model.Island NorthAlberniNanaimoGreater VictoriaCourtenayLake CowichanCowichanCampbell RiverLadysmithSaanichSookeGulf IslandsQualicumCariboo–ChilcotinTrailNorth ThompsonKootenay LakeLillooetRevelstoke100 Mile HouseKamloopsSalmon ArmCrestonCastlegarCentral OkanaganNelsonGoldenArmstrongWindermerePrincetonCranbrookPentictonSouth OkanaganSummerlandVernonKeremeosKimberleyEnderbyKettle ValleySouth CaribooGrand ForksMerrittArrow LakesPeace River NorthQuesnelPrince GeorgeSmithersPeace River SouthBurns LakeFort NelsonPrince RupertKitimatNechakoTerraceChilliwackLangleyMaple RidgeMissionAbbotsfordAgassiz–HarrisonHopeNew WestminsterDeltaSouth Surrey–White RockCoquitlamSurreyBurnabyVan. Downtown EastsideSunshine CoastVancouver City CentrePowell RiverNorth VancouverHowe SoundVancouver WestsideWest Van.–Bowen IslandVancouver MidtownRichmondVancouver North EastVancouver South18%15%11%11%8%0%0%0%0%-7%-10%-11%-32%14%7%2%0%-6%-7%-16%-18%-25%-38%-46%-47%0%3%4%-2%-3%7%0%0%-2%2%0%-10%-4%3%-4%7%0%3%-5%6%0%0%-4%-8%-8%0%0%0%0%-4%10%0%0%-2%-6%1%0%-1%18%6%3%7%-1%0%0%0%3%0%0%0%17%12%8%11%10%46%19%-3%-6%-8%-12%-9%-32%12%5%0%13%-8%-8%-19%-20%-25%-38%-44%-44%21%20%16%14%12%11%10%8%5%3%0%0%-5%35%35%29%25%24%24%23%23%19%16%14%10%10%9%6%0%0%0%0%0%0%0%0%0%0%0%0%0%-4%-8%28%22%21%17%14%10%9%5%0%0%0%-6%0%0%6%0%-9%0%0%0%3%0%0%0%-8%7%0%0%0%0%0%3%3%12%-6%3%-4%-21%-7%-7%0%0%3%0%6%3%0%0%0%0%-9%0%-6%0%-6%-4%0%0%-4%-15%-20%0%0%0%0%22%21%16%11%12%17%10%8%0%2%13%10%-5%35%35%31%27%26%23%24%23%17%13%17%9%12%15%7%27%26%24%17%5%24%0%18%12%10%0%0%10%0%0%26%22%21%17%14%12%11%6%10%43%4%-4%-7%-3%5%-7%0%-5%-5%0%-2%0%-3%0%0%-5%-12%0%-10%0%-4%-4%11%9%-8%2%-10%-12%0%11%12%2%9%6%4%3%7%0%0%0%4%-5%0%-16%-3%0%-8%0%0%-9%0%0%6%0%0%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h8 5Neurological drugs3.2Antipsychoticst h e  B C  r x  a t l a s ,  2 n d  e d i t i o n8 6Introductionfigure 3.2d» Spending per capita in BC, by age group and source of finance, 2006figure 3.2B» Percentage of spending within category by specific drug types, 2006figure 3.2C» Percentage of drug types within category covered by BC PharmaCare, 2006figure 3.2a» Spending within category relative to spending on all prescription drugs, 2006Others 3%Clozapine 12%Risperidone 18%Quetiapine 25%Olanzapine 42%Total drug spendingper capitaSpending per capita on antipsychotics$19 $410OthersClozapineRisperidoneQuetiapineOlanzapine3%12%18%25%42%Unrestricted coverageListing status as of December 2006Restricted coverage10%90%3.2 Neurological: AntipsychoticsCommon goal of therapyReduce symptoms of psychosis• Examples of indicated conditionsSchizophrenia• Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$40$30$20$100-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population80604020$0.60Private spendingPublic spending28142024 24 23326514%86%18%82%30%70%35%65%30%70%29%71%26%74%50%50%$16.54$24.07$29.86$27.57$19.42$17.23$24.3818%82%15%85%13%87%13%87%9%91%8%92%7%93%36%64%$4.8743% private;57% public47% private;53% publicUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyOthers 3%Clozapine 12%Risperidone 18%Quetiapine 25%Olanzapine 42%Total drug spendingper capitaSpending per capita on antipsychotics$19 $410OthersClozapineRisperidoneQuetiapineOlanzapine3%12%18%25%42%Unrestricted coverageListing status as of December 2006Restricted coverage10%90%Total spending in BC: $76-millionSpending per capita in BC: $19.19Dispensing fees as percent of spending: 12%Users of treatment per 1,000 pop. in BC: 20Spending per user of treatment in BC: $936.31Days of treatment per user in BC: 275Cost of treatment per day in BC: $3.40U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h8 7figure 3.2e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $76 million, or $19.19 per capita, on antipsychotic drugs in 2006. The average cost per day of antipsychotic drugs was among the highest among therapeutic categories studied.While only about 2% of BC residents filled an antipsy-chotic prescription, the cost per day of antipsychotic treatment was $3.40 and the average duration of treatment was 275 days. This made antipsychotics the third most expensive therapeutic category studied in terms of cost per patient treated, and the fifth largest in terms of spending per capita.Leading drugs in classDrugs referred to as atypical antipsychotics accounted for most of the spending in the therapeutic category; this type of antipsychotic drug includes the leading medicine, olanzapine, which accounted for 42% of antipsychotic spending.Provincial formulary coverageBC PharmaCare provided some level of coverage for all 21 types of antipsychotic drug sold in Canada in 2006.Spending and use by ageUse of and spending on antipsychotic drugs in BC was more evenly spread across adult age groups than most other therapeutic categories studied. While spending on antipsychotic drugs was negligible among children, spending by age group peaked at $29.86 per person aged 40–49. BC PharmaCare financed a significant majority of spending on antipsy-chotics for all adult age groups.Approximately 20 to 24 people per 1,000 aged 30–69 filled at least one antipsychotic prescription in 2006 and more than 65 people per 1,000 aged 80 and older did so.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$40$30$20$100-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population80604020$0.60Private spendingPublic spending28142024 24 23326514%86%18%82%30%70%35%65%30%70%29%71%26%74%50%50%$16.54$24.07$29.86$27.57$19.42$17.23$24.3818%82%15%85%13%87%13%87%9%91%8%92%7%93%36%64%$4.8743% private;57% public47% private;53% publicUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n8 8Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 3.2a» Variation in spending per capita by local health area, 20063.2 Neurological: AntipsychoticsRegional variations in spending per capitaAfter we accounted for differences in population age, sex, and health status, spending on antipsychotics across BC’s LHAs in 2006 was marked by relatively few extremes surrounding a large number of regions at or near the provincial average.Spending per capita on antipsychotics in 55 LHAs was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Antipsychotic spending in Vancouver Downtown Eastside and Quesnel were far greater than levels predicted based on provincial averages.Greater VictoriaAlberniSookeCowichanLake CowichanLadysmithNanaimoQualicumCourtenayCampbell RiverGulf IslandsSaanichIsland NorthKamloopsCastlegarCentral OkanaganVernonCranbrookKimberleyCrestonArrow LakesTrailGrand ForksKettle ValleySouth OkanaganPentictonKeremeosPrincetonGoldenRevelstokeSalmon ArmArmstrongNorth ThompsonLillooetSouth CaribooMerrittSummerlandEnderbyKootenay LakeNelson100 Mile HouseCariboo–ChilcotinWindermereQuesnelNechakoSmithersPrince RupertBurns LakePrince GeorgeKitimatFort NelsonTerracePeace River SouthPeace River North$32.5$14.1$11.4$18.0$11.3$9.9$21.1$13.1$16.4$12.7$10.2$14.1$9.5$19.7$13.7$23.1$27.4$20.0$11.9$15.3$12.5$25.5$18.8$7.2$28.1$36.7$21.7$18.3$6.5$16.2$19.7$11.9$12.0$11.3$10.4$15.2$18.8$11.6$10.6$18.7$10.2$12.9$5.6$20.7$11.6$13.1$13.1$7.4$19.7$23.4$8.2$25.7$14.4$7.5$26.4$14.1$12.7$18.6$15.1$12.9$24.6$16.6$16.6$13.0$11.7$16.3$11.9$15.4$11.8$20.1$26.6$18.1$11.8$15.7$12.6$19.7$16.0$8.3$21.8$26.4$18.8$15.9$9.0$20.8$19.5$15.5$11.8$9.9$10.7$14.2$17.4$15.9$11.0$19.5$10.8$14.8$6.8$12.3$10.3$12.3$13.5$10.9$18.3$16.5$10.2$27.4$15.3$9.521%1%0%0%0%0%0%0%0%0%-13%-14%-23%24%15%14%3%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-3%-4%-6%-14%-19%53%12%7%0%0%0%0%0%0%-7%-24%Agassiz–HarrisonMissionChilliwackHopeAbbotsfordDeltaNew WestminsterBurnabyMaple RidgeCoquitlamLangleySurreySouth Surrey–White RockVan. Downtown EastsideVancouver North EastRichmondNorth VancouverSunshine CoastPowell RiverHowe SoundVancouver City CentreVancouver WestsideVancouver MidtownVancouver SouthWest Van.–Bowen Island$12.4$24.8$18.1$21.1$16.1$12.9$33.0$14.6$18.9$16.1$13.5$14.8$15.8$108.1$18.3$12.0$16.0$19.3$23.9$9.7$34.9$13.2$28.8$15.4$9.5$9.9$21.7$16.3$20.5$17.7$15.7$28.9$17.3$15.9$17.6$15.1$16.7$22.8$48.4$18.2$16.7$15.7$19.8$31.8$12.6$25.3$16.2$24.7$17.3$12.223%13%11%3%0%0%0%0%0%0%-11%-12%-37%80%1%0%0%0%0%0%0%0%0%-12%-24%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h8 9Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.2G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.2f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson368-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%25541Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita36825541Users per 1,0006671010832Days per user5948125Cost per day474146341t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n9 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.2» Variation in users of treatment per 1,000 residents by local health area, 20063.2 Neurological: AntipsychoticsRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status, there were significant variations across BC’s LHAs in the number of antipsychotic drug users per 1,000 residents in 2006. These variations occurred across and within health authorities.When we accounted for differences in population age, sex, and health status, the rate of antipsychotic drug use was most varied across Vancouver Coastal LHAs.Greater VictoriaAlberniCowichanCourtenayCampbell RiverGulf IslandsSookeNanaimoIsland NorthSaanichQualicumLadysmithLake CowichanPentictonKamloopsSouth OkanaganTrailCastlegarCentral OkanaganCranbrookVernonKimberleyCrestonArrow LakesGrand ForksKettle ValleyKeremeosPrincetonSalmon ArmNorth ThompsonLillooetSouth CaribooMerrittSummerlandKootenay LakeNelson100 Mile HouseWindermereCariboo–ChilcotinRevelstokeArmstrongGoldenEnderbyQuesnelKitimatNechakoSmithersPrince RupertPrince GeorgeFort NelsonPeace River SouthTerracePeace River NorthBurns Lake3123212019201723161819161534253027212522221921181913232319141918222318201912181814111332261518161891820111126212220192118261821242120251923221822202319211917152019191517182121162118152022181518181813161718121822141618%8%0%0%0%0%-10%-14%-15%-16%-23%-25%-32%32%25%24%23%19%13%10%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-9%-21%-28%-30%-35%58%35%0%0%0%0%0%0%-10%-21%-39%Agassiz–HarrisonMaple RidgeChilliwackMissionNew WestminsterHopeAbbotsfordCoquitlamSurreyLangleyBurnabyDeltaSouth Surrey–White RockVan. Downtown EastsideVancouver City CentreVancouver MidtownVancouver North EastNorth VancouverSunshine CoastVancouver SouthWest Van.–Bowen IslandVancouver WestsidePowell RiverHowe SoundRichmond212322232726191617151715187133241919211718162813131619202125242118191820192633252119192220221935161828%16%11%9%9%0%-10%-12%-14%-15%-18%-21%-39%77%30%13%0%0%0%-12%-19%-21%-25%-26%-33%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h9 1Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.2G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.2h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson6671010832 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita36825541Users per 1,0006671010832Days per user5948125Cost per day474146341t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n9 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 3.2C» Variation in days of treatment per user by local health area, 20063.2 Neurological: AntipsychoticsRegional variations in days of treatmentAfter we accounted for differences in population age, sex, and health status, there was moderate variation across BC’s LHAs in the average number of days of treatment received per user of antipsychotic drugs in 2006.In 48 LHAs, average days of treatment received per user of antipsychotics was either within 5% of, or not statisti-cally significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Antipsychotic users in several Interior, Northern, and Vancouver Island LHAs received fewer days of treatment than predicted based on provincial averages.Greater VictoriaCowichanCourtenayCampbell RiverSaanichQualicumLake CowichanNanaimoSookeAlberniGulf IslandsLadysmithIsland NorthVernonPentictonKamloopsTrailCentral OkanaganCranbrookKimberleyCrestonArrow LakesGrand ForksKettle ValleyPrincetonSalmon ArmNorth ThompsonLillooetMerrittSummerlandArmstrongGoldenEnderbySouth OkanaganNelsonCariboo–ChilcotinCastlegarKeremeosRevelstokeSouth CaribooWindermere100 Mile HouseKootenay LakeKitimatPrince RupertPrince GeorgeFort NelsonTerracePeace River NorthQuesnelSmithersPeace River SouthNechakoBurns Lake2902752572472592522692752522312282192093032702722852642892552872462882452362502681932362392562172512352462342142322321992061791712372692642333102422232312352272212902782612592652682802862702742772742712732702682692662902792632772712512732692572552552652742702522652822782552802892632832502872652712742682952752562652792722830%0%0%0%0%0%0%-4%-7%-17%-19%-22%-26%10%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-12%-14%-17%-17%-19%-22%-28%-32%-33%-52%0%0%0%0%0%-13%-14%-14%-17%-18%-25%Maple RidgeMissionNew WestminsterLangleyCoquitlamSurreyChilliwackHopeAbbotsfordBurnabyDeltaSouth Surrey–White RockAgassiz–HarrisonVancouver City CentreNorth VancouverVan. Downtown EastsideVancouver MidtownVancouver North EastVancouver SouthVancouver WestsideRichmondSunshine CoastHowe SoundPowell RiverWest Van.–Bowen Island28830731829329127427524828227927128523430527431329828427527527025223326821525427328826927726726627627428026827328528926029929227928027927527226330325212%12%10%9%5%3%0%0%0%0%0%0%-20%5%5%4%0%0%0%0%0%-8%-12%-12%-16%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h9 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.2G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.2i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson59-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%48125Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita36825541Users per 1,0006671010832Days per user5948125Cost per day474146341t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n9 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.2d» Variation in cost of treatment per day by local health area, 20063.2 Neurological: AntipsychoticsRegional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, the average daily cost of antip-sychotic treatments purchased varied considerably across BC’s LHAs in 2006.The average daily cost of antipsychotic treatment in Vancouver Downtown Eastside and several Interior LHAs were well above levels predicted based on provincial averages for populations of the same age, sex, and health status.Supplemental data (available online) show that regional variations in dispensing fees paid per day of antipsychotic treatment were only a fraction of the size of regional variations in the costs of the antipsychotic treatments themselves.SaanichGreater VictoriaLake CowichanLadysmithNanaimoQualicumCourtenayIsland NorthCowichanCampbell RiverSookeAlberniGulf IslandsSouth OkanaganSalmon ArmSummerlandPentictonVernonKeremeosCentral OkanaganCrestonKootenay LakeNelsonCastlegarArrow LakesTrailGrand ForksKettle ValleyPrincetonGoldenRevelstokeArmstrong100 Mile HouseNorth ThompsonLillooetSouth CaribooMerrittEnderbyCranbrookKamloopsCariboo–ChilcotinKimberleyWindermerePrince GeorgePrince RupertSmithersBurns LakeNechakoPeace River SouthKitimatFort NelsonTerraceQuesnelPeace River North$3.02$3.63$2.88$2.77$3.39$2.70$3.14$2.92$3.18$2.73$2.71$2.64$2.24$4.02$4.22$3.39$4.00$4.12$4.06$3.44$2.59$3.46$3.71$3.01$2.81$3.31$3.36$2.24$3.36$2.68$3.99$3.40$3.01$3.12$3.02$2.93$2.94$3.55$3.14$2.93$2.98$2.43$2.21$4.06$3.00$3.23$3.05$3.46$3.39$3.80$3.81$4.21$2.93$2.72$2.79$3.53$3.22$3.10$3.46$2.90$3.18$3.33$3.44$3.12$3.24$3.25$3.09$2.95$3.33$2.74$3.23$3.36$3.34$3.24$2.73$3.65$3.53$3.04$3.14$3.28$3.18$2.64$3.12$2.60$3.58$3.14$3.38$2.97$3.24$2.72$3.11$3.03$3.44$3.38$3.44$3.04$3.10$3.52$3.27$3.29$3.54$3.48$3.57$3.54$3.73$3.91$3.34$3.428%3%0%0%0%0%0%0%-8%-14%-18%-21%-32%31%24%22%21%21%20%6%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-9%-14%-14%-23%-34%14%0%0%0%0%0%0%0%0%-13%-23%HopeNew WestminsterCoquitlamMissionSouth Surrey–White RockSurreyDeltaLangleyChilliwackBurnabyMaple RidgeAbbotsfordAgassiz–HarrisonVan. Downtown EastsideSunshine CoastVancouver MidtownRichmondNorth VancouverWest Van.–Bowen IslandHowe SoundVancouver City CentreVancouver WestsideVancouver North EastVancouver SouthPowell River$3.26$3.83$3.48$3.53$3.09$3.24$3.13$3.00$3.03$3.13$2.92$2.97$2.49$4.89$3.64$4.03$3.48$3.13$2.48$3.28$3.47$3.10$3.39$3.22$3.23$3.53$3.73$3.54$3.60$2.98$3.42$3.31$3.18$3.32$3.46$3.33$3.44$3.24$3.96$3.21$3.86$3.42$3.15$2.62$3.26$3.41$3.14$3.54$3.43$3.570%0%0%0%0%-5%-6%-6%-9%-10%-13%-15%-26%21%13%4%0%0%0%0%0%0%-4%-6%-10%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h9 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.2G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.2J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson47414-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%6341Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita36825541Users per 1,0006671010832Days per user5948125Cost per day474146341t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n9 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 3.2e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20063.2 Neurological: AntipsychoticsSources of spending deviationAfter we accounted for differences in population age, sex, and health status, variations in spending per capita across BC’s LHAs in 2006 resulted almost entirely from variations in the number of users per 1,000 residents.Some LHAs where use differed significantly from rates predicted based on provincial averages for populations of the same age, sex, and health status did not have statistically significant differences in spending. This is largely because our methods for estimating spending per capita involve an adjust-ment for selection bias that reduces confidence intervals for estimates from that model.Greater VictoriaAlberniCowichanCourtenayCampbell RiverQualicumLake CowichanNanaimoLadysmithSookeGulf IslandsSaanichIsland NorthKamloopsCastlegarCentral OkanaganVernonSouth OkanaganSalmon ArmPentictonSummerlandTrailKimberleyCrestonArrow LakesGrand ForksKettle ValleyPrincetonNorth ThompsonLillooetMerrittArmstrongGoldenEnderbyKeremeosRevelstokeSouth CaribooCranbrookKootenay LakeNelson100 Mile HouseCariboo–ChilcotinWindermereQuesnelNechakoSmithersPrince RupertKitimatPrince GeorgeFort NelsonTerraceBurns LakePeace River SouthPeace River NorthAgassiz–HarrisonMissionChilliwackHopeNew WestminsterCoquitlamDeltaBurnabyMaple RidgeAbbotsfordLangleySurreySouth Surrey–White RockVan. Downtown EastsideVancouver North EastSunshine CoastVancouver City CentreNorth VancouverVancouver MidtownVancouver WestsideRichmondHowe SoundPowell RiverVancouver SouthWest Van.–Bowen Island23%13%11%3%0%0%0%0%0%0%-11%-12%-37%80%1%0%0%0%0%0%0%0%0%-12%-24%-20%12%0%0%10%5%0%0%12%0%9%3%0%4%0%-8%5%5%0%0%0%-12%-12%0%-16%-26%0%-9%0%0%0%-6%-10%-13%-15%-6%-5%0%21%-4%13%0%0%4%0%0%0%-10%-6%0%28%9%11%0%9%-12%-21%-18%16%-10%-15%-14%-39%77%0%0%30%0%13%-21%-33%-26%-25%-12%-19%21%1%0%0%0%0%0%0%0%0%-13%-14%-23%24%15%14%3%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-3%-4%-6%-14%-19%53%12%7%0%0%0%0%0%0%-7%-24%0%-17%0%0%0%0%0%-4%-22%-7%-19%0%-26%0%-17%0%10%-12%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-19%-22%-28%0%-52%-14%-33%-17%-32%-14%-18%-14%0%0%0%0%0%-25%-17%-13%18%8%0%0%0%-23%-32%-14%-25%-10%0%-16%-15%25%19%13%0%24%0%32%0%23%0%0%0%0%0%0%0%0%0%-28%-30%-35%0%-21%0%10%0%0%0%-9%0%58%0%0%0%35%0%0%-10%-39%0%-21%3%-21%-8%0%-14%0%0%0%0%-18%-32%8%0%-14%0%6%21%31%24%21%22%0%-23%0%0%0%0%0%0%0%0%0%0%0%20%0%0%-9%0%0%0%-14%-34%-13%0%0%0%0%14%0%0%0%0%-23%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h9 7Neurological drugsGabapentin, pregabalin, topiramate3.3t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n9 8Introductionfigure 3.3d» Spending per capita in BC, by age group and source of finance, 2006figure 3.3a» Spending within category relative to spending on all prescription drugs, 20063.3 Neurological: Gabapentin, pregabalin, topiramateCommon goal of therapyReduce certain kinds of seizures • (gabapentin, topiramate)Reduce neuropathic pain (pregabalin)• Prevent migraine headaches (topiramate)• Examples of indicated conditionsEpilepsy• Nerve pain caused by diabetes mellitus• Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$20$15$10$50-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population40302010$0.30 $0.69$2.30$4.98$8.80$11.56$12.79$14.89 $15.0131%69%35%65%46%54%52%48%48%52%44%56%35%65%45% private;55% public65% private;35% public36% private;64% public37% private;63% public0 1510162126353926%74%31%69%51%49%64%36%62%38%59%41%53%47%Private spendingPublic spendingUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyPregabalin 11%Topiramate 22%Gabapentin 67%Total drug spendingper capitaSpending per capita on gabapentin, pregabalin, and topiramate$7 $410PregabalinTopiramateGabapentin11%22%67%Unrestricted coverageListing status as of December 2006Not covered33%67%Total spending in BC: $28-millionSpending per capita in BC: $7.13Dispensing fees as percent of spending: 10%Users of treatment per 1,000 pop. in BC: 14Spending per user of treatment in BC: $492.50Days of treatment per user in BC: 179Cost of treatment per day in BC: $2.74figure 3.3C» Percentage of drug types within category covered by BC PharmaCare, 2006figure 3.3B» Percentage of spending within category by specific drug types, 2006Pregabalin 11%Topiramate 22%Gabapentin 67%Total drug spendingper capitaSpending per capita on gabapentin, pregabalin, and topiramate$7 $410PregabalinTopiramateGabapentin11%22%67%Unrestricted coverageListing status as of December 2006Not covered33%67%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h9 9figure 3.3e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $28 million, or $7.13 per capita, on gabapentin, pregabalin, and topiramate in 2006. In terms of spending per capita, this was the 14th largest therapeutic category studied.While only 14 per 1,000 BC residents filled a gabapen-tin, pregabalin, or topiramate prescription, the average cost per day of treatment was $2.74 and the average user received 179 days of therapy. These factors made this category the sixth most expensive in terms of cost per patient treated ($492.50).Leading drugs in classGabapentin accounted for two-thirds of spending in this therapeutic category.Provincial formulary coverageIn 2006, BC PharmaCare provided coverage for gabap-entin and topiramate but did not cover pregabalin.Spending and use by ageSpending on and use of gabapentin, pregabalin, or topiramate increased relatively uniformly across age groups.Spending was negligible among children under age 10, but increased steadily to approximately $15 per capita among residents aged 80 and older. BC PharmaCare financed a majority of spending in all age groups except 50–59. Use of gabapentin, pregabalin, or topiramate was extremely rare among BC residents under age 20. Among adults, use increased relatively steadily across age groups, peaking at 39 per 1,000 people aged 80 and older.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$20$15$10$50-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population40302010$0.30 $0.69$2.30$4.98$8.80$11.56$12.79$14.89 $15.0131%69%35%65%46%54%52%48%48%52%44%56%35%65%45% private;55% public65% private;35% public36% private;64% public37% private;63% public0 1510162126353926%74%31%69%51%49%64%36%62%38%59%41%53%47%Private spendingPublic spendingUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 0 0Spending per capitatable 3.3a» Variation in spending per capita by local health area, 2006Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Regional variations in spending per capitaAfter we accounted for differences in population age, sex, and health status, spending per capita on gabap-entin, pregabalin, and topiramate across BCs LHAs in 2006 was marked by relatively few but extreme outliers.In 56 LHAs, spending per capita on gabapentin, pregabalin, and topiramate was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Spending per capita on gabapentin, pregabalin, and topiramate in large Vancouver Island LHAs was far higher than predicted based on provincial averages, while the opposite was true for several suburban Vancouver Coastal and Fraser LHAs.NanaimoSookeGreater VictoriaSaanichGulf IslandsCowichanLake CowichanLadysmithQualicumAlberniIsland NorthCampbell RiverCourtenay100 Mile HouseNelsonKamloopsSalmon ArmCranbrookKimberleyWindermereKootenay LakeCastlegarArrow LakesTrailGrand ForksKettle ValleySouth OkanaganPentictonKeremeosPrincetonGoldenRevelstokeArmstrongVernonCentral OkanaganNorth ThompsonCariboo–ChilcotinLillooetSouth CaribooMerrittSummerlandCrestonEnderbyTerraceFort NelsonQuesnelPrince RupertSmithersBurns LakeNechakoPrince GeorgePeace River SouthKitimatPeace River North$12.6$9.9$11.2$9.0$7.5$9.3$13.8$7.6$11.4$9.4$8.0$6.5$6.9$10.5$7.0$7.8$7.6$7.6$5.8$3.1$5.9$7.0$6.0$10.2$4.4$7.5$11.3$9.9$9.5$14.6$4.8$4.4$6.9$9.2$7.6$9.8$8.4$13.6$7.6$14.0$7.7$8.1$9.1$9.4$2.1$8.4$4.8$4.5$7.7$4.2$6.0$4.8$6.2$3.4$8.5$7.2$8.3$8.0$8.0$8.6$8.3$8.1$9.2$6.4$6.3$8.0$8.9$6.8$6.1$7.4$7.6$6.8$7.0$3.9$4.9$6.4$7.9$7.9$6.0$6.9$8.8$8.3$8.5$7.9$5.2$5.5$6.9$8.7$7.7$5.5$6.6$7.5$8.2$8.9$7.6$8.9$10.2$8.2$2.0$6.5$6.5$4.9$6.1$4.1$6.1$4.8$8.1$4.739%32%30%0%0%0%0%0%0%0%0%-20%-26%44%14%6%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-10%-11%13%5%0%0%0%0%0%0%0%-26%-31%ChilliwackHopeAbbotsfordLangleyNew WestminsterMaple RidgeMissionAgassiz–HarrisonSouth Surrey–White RockCoquitlamDeltaSurreyBurnabyVan. Downtown EastsideVancouver City CentreSunshine CoastNorth VancouverWest Van.–Bowen IslandPowell RiverHowe SoundVancouver WestsideVancouver MidtownVancouver North EastVancouver SouthRichmond$11.1$13.1$7.9$7.6$8.8$9.1$9.1$10.5$7.8$5.2$5.7$5.2$4.8$11.0$8.1$9.3$6.4$6.4$10.6$5.9$5.5$4.8$4.2$4.3$4.0$7.4$9.6$7.0$6.7$8.3$7.5$7.2$4.8$9.2$6.0$6.9$6.5$6.4$8.5$7.2$8.8$7.2$8.2$8.0$6.0$6.6$6.1$6.0$6.1$6.241%0%0%0%0%0%0%0%0%-15%-19%-22%-28%25%11%5%0%0%0%0%0%0%-34%-36%-46%3.3 Neurological: Gabapentin, pregabalin, topiramateU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 0 1figure 3.3f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliableSnow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson143-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%53756Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita14353756Users per 1,0001016439928Days per user77605Cost per day491382142t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 0 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentstable 3.3B» Variation in users of treatment per 1,000 residents by local health area, 2006Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status, there were major regional variations in the number of gabapentin, pregabalin, or topiramate users per 1,000 residents across BC’s LHAs in 2006.Significant variations in the rate of use of gabapentin, pregabalin, or topiramate were observed across the province and within all health authorities.With the exception of Vancouver Downtown Eastside and City Centre, the use of gabapentin, pregabalin, or topiramate in Vancouver Coastal LHAs was much lower than predicted based on provincial averages for populations of the same age, sex, and health status.Lake CowichanAlberniNanaimoSookeGreater VictoriaQualicumIsland NorthSaanichGulf IslandsCowichanLadysmithCampbell RiverCourtenayLillooetPrincetonNorth Thompson100 Mile HouseMerrittTrailSouth OkanaganCariboo–ChilcotinPentictonNelsonKamloopsSalmon ArmCranbrookKimberleyKootenay LakeCastlegarKettle ValleyKeremeosGoldenArmstrongVernonCentral OkanaganSouth CaribooSummerlandCrestonEnderbyWindermereRevelstokeArrow LakesGrand ForksBurns LakeQuesnelTerraceFort NelsonSmithersNechakoPrince GeorgePeace River SouthPrince RupertKitimatPeace River North262223182124151915171612122729222529222316201714141410121613171214181515161313891210181714811101210911616151613161912171616171516141612161917181316141414131210141315121417151615141610121614131313712101310121594 8%39%37%30%28%22%21%13%0%0%0%-23%-28%65%61%61%48%44%27%24%24%18%16%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-23%-25%-29%-33%27%23%0%0%0%0%0%0%-28%-33%-37%Agassiz–HarrisonChilliwackHopeMissionMaple RidgeAbbotsfordLangleyNew WestminsterCoquitlamSouth Surrey–White RockDeltaSurreyBurnabyPowell RiverVan. Downtown EastsideVancouver City CentreSunshine CoastHowe SoundNorth VancouverVancouver WestsideWest Van.–Bowen IslandVancouver MidtownVancouver North EastVancouver SouthRichmond22202418181715171117121211211915161214111510101191114181415141316131915141516151416121514191314151372%39%28%23%19%14%11%0%-14%-14%-16%-18%-25%27%22%8%0%0%-10%-19%-23%-25%-30%-32%-44%3.3 Neurological: Gabapentin, pregabalin, topiramateU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 0 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.3h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson1016439928 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita14353756Users per 1,0001016439928Days per user77605Cost per day491382142t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 0 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 3.3C» Variation in days of treatment per user by local health area, 2006Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per userRegional variations in days of treatmentAfter we accounted for differences in population age, sex, and health status, there were modest variations across BC’s LHAs in the average number of days of treatment received per user of gabapentin, pregabalin, or topiramate in 2006.In 60 LHAs, average days of treatment received per user of gabapentin, pregabalin, or topiramate were either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Users of gabapentin, pregabalin, or topiramate in Van-couver Downtown Eastside, Vancouver City Centre, and Greater Victoria received more days of treatment than predicted based on provincial averages.Greater VictoriaNanaimoLake CowichanAlberniSookeQualicumIsland NorthGulf IslandsCowichanLadysmithCampbell RiverCourtenaySaanichCranbrookPrincetonNorth ThompsonTrailSouth OkanaganCariboo–ChilcotinPentictonKamloopsSalmon ArmKimberleyKootenay LakeCastlegarKettle ValleyKeremeosArmstrongSouth CaribooSummerlandCrestonEnderbyWindermereRevelstokeArrow LakesGrand ForksCentral OkanaganVernonMerrittNelson100 Mile HouseGoldenLillooetQuesnelTerraceFort NelsonSmithersPrince GeorgePeace River SouthPrince RupertKitimatPeace River NorthNechakoBurns Lake19519117517318318216019818516718218817019818318717017617618218318018119517119317715516418520217514416118616217116915415614113713618319313916018716317520419915013718218017717 917 718117618217817 817 817 918217918118017918017718217917 918318118018018618117718218517917 917 817 718218018017617917 717 417 417 918017617717 91801771751801811767%6%0%0%0%0%0%0%0%0%0%0%-7%11%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-5%-7%-13%-14%-23%-24%-25%0%0%0%0%0%0%0%0%0%-19%-25%ChilliwackMaple RidgeAgassiz–HarrisonHopeMissionAbbotsfordLangleyNew WestminsterSouth Surrey–White RockCoquitlamDeltaBurnabySurreyVancouver City CentreVan. Downtown EastsideSunshine CoastVancouver WestsidePowell RiverHowe SoundNorth VancouverWest Van.–Bowen IslandVancouver MidtownVancouver North EastRichmondVancouver South19218718220018617618418 818116917016916420519919 719118017118417117817217416917 917 718 417 917 817 918018018217718017917 817 917618018117717 81801821791811801807%5%0%0%0%0%0%0%0%-5%-5%-6%-8%14%12%9%5%0%0%0%0%0%0%0%-7%3.3 Neurological: Gabapentin, pregabalin, topiramateU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 0 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.3i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson77-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%605Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita14353756Users per 1,0001016439928Days per user77605Cost per day491382142t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 0 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per daytable 3.3d» Variation in cost of treatment per day by local health area, 2006Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationRegional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, there was moderate variation in the average cost per day of therapy received by users of gabapentin, pregabalin, or topiramate across BC’s LHAs in 2006.The cost per day of treatment with these medicines in Vancouver Island and Interior LHAs were gener-ally higher than levels predicted based on provincial averages for populations of the same age, sex, and health status.Supplemental data (available online) show that regional variations in dispensing fees paid per day of treatment received were only a fraction of the size of regional variations in the costs of the drugs themselves.Island NorthCampbell RiverCourtenayNanaimoSookeSaanichGreater VictoriaGulf IslandsCowichanLake CowichanLadysmithQualicumAlberniEnderbyLillooetKimberleyKeremeosArmstrongCrestonVernonSalmon ArmMerrittKamloopsCentral OkanaganSouth OkanaganPentictonCranbrookWindermereKootenay LakeNelsonCastlegarArrow LakesTrailGrand ForksKettle ValleyPrincetonGoldenRevelstoke100 Mile HouseCariboo–ChilcotinSouth CaribooSummerlandNorth ThompsonTerraceQuesnelPrince RupertBurns LakeNechakoPeace River SouthPeace River NorthKitimatPrince GeorgeSmithersFort Nelson$3.41$3.08$2.9 7$2.91$3.00$2.72$2.75$2.58$2.8 9$2.9 8$2.80$2.59$2.4 7$ 4.03$3.76$3.33$3.22$3.14$3.20$3.06$2.9 8$3.16$3.04$2.8 8$2.80$2.7 9$2.71$2.66$2.56$2.68$2.59$2.72$2.68$2.76$2.93$2.70$2.9 9$3.01$2.9 7$2.91$3.11$2.68$2.37$3.40$2.75$2.96$3.22$2.67$2.91$2.7 7$2.8 8$2.66$2.4 4$1.92$2.8 7$2.7 7$2.7 8$2.7 4$2.8 7$2.61$2.69$2.65$2.7 9$2.7 7$2.70$2.54$2.68$2.8 4$2.85$2.61$2.65$2.7 4$2.80$2.7 7$2.72$2.8 8$2.8 4$2.70$2.63$2.63$2.76$2.66$2.7 9$2.80$2.75$2.7 7$2.7 7$2.60$2.72$2.73$2.92$2.92$2.8 4$2.8 7$2.85$2.62$2.8 4$2.8 8$2.8 7$2.81$2.83$2.83$2.86$2.8 8$2.91$2.8 9$2.85$2.8517%11%7%6%4%4%2%0%0%0%0%0%-8%35%27%24%19%14%14%10%9%9%7%7%6%6%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-18%17%0%0%0%0%0%0%0%-8%-16%-39%LangleyHopeChilliwackAbbotsfordDeltaNew WestminsterCoquitlamAgassiz–HarrisonSouth Surrey–White RockSurreyMissionMaple RidgeBurnabySunshine CoastWest Van.–Bowen IslandPowell RiverHowe SoundVan. Downtown EastsideVancouver WestsideRichmondVancouver City CentreNorth VancouverVancouver MidtownVancouver North EastVancouver South$2.86$2.76$2.83$2.71$2.68$2.73$2.75$2.67$2.57$2.72$2.75$2.67$2.52$2.9 4$2.46$2.75$2.81$2.8 9$2.57$2.66$2.57$2.54$2.59$2.45$2.39$2.72$2.7 8$2.76$2.7 8$2.72$2.76$2.81$2.72$2.59$2.85$2.8 7$2.8 4$2.71$2.66$2.57$2.7 7$2.76$2.86$2.60$2.75$2.71$2.71$2.7 9$2.68$2.665%0%0%0%0%0%0%0%0%-4%-4%-6%-7%10%0%0%0%0%0%-3%-5%-7%-7%-9%-10%3.3 Neurological: Gabapentin, pregabalin, topiramateU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 0 7Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.3G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.3J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson4913821-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%42Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita14353756Users per 1,0001016439928Days per user77605Cost per day491382142t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 0 8Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationtable 3.3e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,0003.3 Neurological: Gabapentin, pregabalin, topiramateSources of spending deviationAfter we accounted for differences in population age, sex, and health status, variations across BC’s LHAs in spending per capita on gabapentin, pregabalin, and topiramate resulted almost entirely from variations in the number of users per 1,000 residents in 2006.Some LHAs where use differed significantly from rates predicted based on provincial averages for populations of the same age, sex, and health status did not have statistically significant differences in spending. This is largely because our methods for estimating spending per capita involve an adjust-ment for selection bias that reduces confidence intervals for estimates from that model.NanaimoSookeGreater VictoriaLake CowichanIsland NorthSaanichAlberniQualicumGulf IslandsCowichanLadysmithCampbell RiverCourtenay100 Mile HouseNelsonKamloopsSalmon ArmKimberleyMerrittCentral OkanaganVernonCranbrookPrincetonNorth ThompsonTrailSouth OkanaganCariboo–ChilcotinPentictonKootenay LakeCastlegarKettle ValleyKeremeosArmstrongSouth CaribooSummerlandWindermereRevelstokeArrow LakesGrand ForksGoldenLillooetCrestonEnderbyTerraceFort NelsonQuesnelSmithersPeace River SouthPrince RupertNechakoBurns LakePrince GeorgeKitimatPeace River NorthChilliwackAgassiz–HarrisonHopeLangleyNew WestminsterSouth Surrey–White RockAbbotsfordMaple RidgeMissionCoquitlamDeltaSurreyBurnabyVan. Downtown EastsideVancouver City CentreSunshine CoastVancouver WestsidePowell RiverHowe SoundWest Van.–Bowen IslandNorth VancouverVancouver MidtownVancouver North EastVancouver SouthRichmond41%0%0%0%0%0%0%0%0%-15%-19%-22%-28%25%11%5%0%0%0%0%0%0%-34%-36%-46%7%0%0%0%0%0%0%5%0%-5%-5%-8%-6%12%14%9%5%0%0%0%0%0%0%-7%0%0%0%0%5%0%0%0%-6%-4%0%0%-4%-7%0%-5%10%0%0%0%0%-7%-7%-9%-10%-3%39%72%28%11%0%-14%14%19%23%-14%-16%-18%-25%22%8%0%-19%27%0%-23%-10%-25%-30%-32%-44%39%32%30%0%0%0%0%0%0%0%0%-20%-26%44%14%6%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-10%-11%13%5%0%0%0%0%0%0%0%-26%-31%6%0%7%0%0%-7%0%0%0%0%0%0%0%-23%-14%0%0%0%-13%-5%-7%11%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-24%-25%0%0%0%0%0%0%0%0%-19%-25%0%0%0%37%30%28%48%21%13%39%22%0%0%0%-23%-28%48%16%0%0%0%44%0%0%0%61%61%27%24%24%18%0%0%0%0%0%0%0%-23%-25%-29%-33%0%65%0%0%0%0%23%0%0%-28%0%27%0%-33%-37%6%4%2%0%17%4%-8%0%0%0%0%11%7%0%0%7%9%24%9%7%10%0%0%-18%0%6%0%6%0%0%0%19%14%0%0%0%0%0%0%0%27%14%35%17%-39%0%-16%0%0%0%0%-8%0%0%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 0 9Neurological drugsBenzodiazepines and related drugs3.4t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 1 0IntroductionNumberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$20$15$10$50-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population24018012060$0.17 $0.40$1.60$3.98$7.45$10.94$13.19$17.12$22.4250%50%54%46%64%36%66%34%59%41%57%43%55%45%63% private;37% public59% private;41% public69% private;31% public77% private;23% publicPrivate spendingPublic spending21037639012314918721642%58%51%49%70%30%80%20%79%21%78%22%73%27%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyfigure 3.4d» Spending per capita in BC, by age group and source of finance, 2006figure 3.4C» Percentage of drug types within category covered by BC PharmaCare, 2006figure 3.4B» Percentage of spending within category by specific drug types, 2006figure 3.4a» Spending within category relative to spending on all prescription drugs, 2006Others 20%Lorazepam 14%Zopiclone 66%Total drug spendingper capitaSpending per capita on benzodiazepines and related drugs$7 $410OthersLorazepamZopiclone20%14%66%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered8%8%85%Common goal of therapyReduce symptoms of short term insomnia •	and anxietyExamples of indicated conditionsInsomnia related to a stressful life event•	Others 20%Lorazepam 14%Zopiclone 66%Total drug spendingper capitaSpending per capita on benzodiazepines and related drugs$7 $410OthersLorazepamZopiclone20%14%66%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered8%8%85%3.4 Neurological: Benzodiazepines and related drugsTotal spending in BC: $28-millionSpending per capita in BC: $7.04Dispensing fees as percent of spending: 49%Users of treatment per 1,000 pop. in BC: 84Spending per user of treatment in BC: $83.83Days of treatment per user in BC: 144Cost of treatment per day in BC: $0.58U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 1 1figure 3.4e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $28 million, or $7.04 per capita, on benzodiazepines and related drugs in 2006. In terms of spending per capita, this was the 15th largest therapeutic category studied.In 2006, 84 out of every 1,000 BC residents filled a prescription for benzodiazepines or related drugs. Users received an average of 144 days of treatment—which is more than is commonly recommended (see Appendix C on rates of long-term use).The average cost per day of these treatments was $0.58, the lowest of all therapeutic categories studied.Leading drugs in classZopiclone accounted for two-thirds of spending in this therapeutic category, and lorazepam accounted for 14%. Provincial formulary coverageIn 2006, BC PharmaCare provided coverage for 12 out of 13 types of benzodiazepines and related drugs.Spending and use by ageSpending on and use of benzodiazepines and related drugs increased relatively steadily across age groups.Spending on benzodiazepines and related drugs was very low among residents under age 20, but increased steadily to approximately $22 per capita among residents aged 80 and older. BC PharmaCare financed a minority of spending in this therapeutic category. The age gradient in use of benzodiazepines and related drugs was not as steep as the gradient in spending. Use was rare among children under 10, but approximately one in 100 teens filled at least one prescription from this therapeutic category. Use increased steadily across age groups to the point that one in five residents aged 80 and older filled at least one benzodiazepine or related prescription.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$20$15$10$50-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population24018012060$0.17 $0.40$1.60$3.98$7.45$10.94$13.19$17.12$22.4250%50%54%46%64%36%66%34%59%41%57%43%55%45%63% private;37% public59% private;41% public69% private;31% public77% private;23% publicPrivate spendingPublic spending21037639012314918721642%58%51%49%70%30%80%20%79%21%78%22%73%27%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 1 2Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 3.4a» Variation in spending per capita by local health area, 2006Regional variations in spending per capitaAfter we accounted for differences in population age, sex, and health status, spending per capita on benzo-diazepines or related drugs varied significantly across BC’s LHAs in 2006.Spending per capita on benzodiazepines and related drugs in only 34 LHAs was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status. Spending on benzodiazepines varied significantly across LHAs within the Vancouver Coastal, Fraser, and Northern health authorities.AlberniNanaimoCampbell RiverGreater VictoriaQualicumGulf IslandsSaanichLake CowichanLadysmithSookeCowichanIsland NorthCourtenayPrincetonPentictonKeremeosCariboo–ChilcotinRevelstokeCranbrookSalmon ArmGoldenKamloopsSouth OkanaganSouth CaribooSummerland100 Mile HouseEnderbyCrestonKimberleyWindermereKootenay LakeCastlegarArrow LakesTrailKettle ValleyArmstrongVernonCentral OkanaganNorth ThompsonLillooetNelsonGrand ForksMerrittBurns LakePeace River NorthPeace River SouthNechakoPrince RupertFort NelsonTerraceSmithersQuesnelPrince GeorgeKitimat$9.2$ 9. 8$ 8. 8$10.0$11.2$7. 9$ 8. 7$10.2$8. 9$6.5$7. 7$5.8$ 7.5$17.6$15.6$12.9$ 8.2$6.1$8. 8$11.9$6.8$ 8. 4$13.1$9.1$11.5$9.5$ 9.2$ 9.2$ 7.1$5.8$3.5$6.3$6.7$ 8.3$6.1$6.4$ 9.3$ 9.5$ 4.6$6.5$5.0$8.0$ 8. 8$ 9. 9$ 4. 4$6.7$ 4.2$5.5$3.8$6.7$ 4. 9$6.2$4.6$5.2$7.2$ 8.3$ 7. 8$ 9.0$10.1$7.3$ 8.1$ 9.6$ 8.5$6.5$8.0$5.7$ 8.2$12.5$11.2$9.2$6.5$5.0$7.1$ 9. 7$5.6$7.0$11.2$7. 9$10.1$8.6$ 8. 8$ 8. 8$ 7.5$ 4. 9$3.7$6.3$6.9$ 7.6$5.9$6.3$9.0$ 8.5$ 4. 8$6.1$5.0$8.2$10.8$6.4$3.6$5.7$3.8$5.4$2.8$6.4$5.0$6.5$5.1$6.325%16%12%11%10%8%7%5%5%0%0%0%-8%34%34%33%23%21%21%20%19%18%15%14%13%10%4%4%0%0%0%0%0%0%0%0%0%0%0%0%-2%-3%-21%44%20%16%8%0%0%0%-1%-5%-11%-19%Agassiz–HarrisonHopeLangleyMissionChilliwackMaple RidgeNew WestminsterSouth Surrey–White RockDeltaAbbotsfordSurreyCoquitlamBurnabyPowell RiverVancouver City CentreSunshine CoastVan. Downtown EastsideWest Van.–Bowen IslandVancouver WestsideNorth VancouverHowe SoundRichmondVancouver MidtownVancouver SouthVancouver North East$ 7. 9$11.0$6.6$6.9$ 7.5$ 7.3$ 8.6$10.0$6.1$5.9$5.3$4. 9$5.0$13.7$ 9.0$10.4$12.3$8. 4$6.6$6.0$3.9$ 4.5$ 4. 7$ 4.2$3.7$5.2$8.6$6.2$6.6$7.3$ 7.1$ 8. 4$ 9.1$6.4$6.5$6.0$5.6$6.3$10.1$7. 4$ 8. 7$11.1$8.0$6.2$6.4$ 4.6$5.4$5.8$5.8$5.442%24%7%5%4%4%3%0%-5%-9%-12%-13%-23%31%20%19%11%5%0%-7%-16%-19%-22%-33%-37%3.4 Neurological: Benzodiazepines and related drugsU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 1 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.4G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.4f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson1361266234 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita1361266234Users per 1,000962194228Days per user171736315Cost per day45151252t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 1 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.4B» Variation in users of treatment per 1,000 residents by local health area, 2006Regional variations in rate of useAfter we accounted for differences in population age, sex, and health status, there were major variations across BC’s LHAs in the number of users of benzodi-azepines and related drugs per 1,000 residents in 2006. Use of benzodiazepines and related drugs in only 28 LHAs was either within 5% of, or not statistically significantly different from, rates predicted based on provincial averages for populations of the same age, sex, and health status.Even after we accounted for differences in popula-tion age, sex, and health status, the rate of use of benzodiazepines or related drugs varied significantly across LHAs within the Vancouver Coastal, Fraser, and Northern health authorities.AlberniNanaimoCampbell RiverGulf IslandsGreater VictoriaQualicumSaanichLake CowichanLadysmithSookeIsland NorthCowichanCourtenayPentictonPrincetonKeremeosRevelstokeCariboo–ChilcotinCranbrookGoldenKamloopsWindermereSalmon ArmSouth OkanaganSouth CaribooCentral OkanaganTrailSummerland100 Mile HouseVernonEnderbyCrestonKootenay LakeCastlegarArrow LakesKettle ValleyArmstrongNorth ThompsonLillooetNelsonGrand ForksKimberleyMerrittBurns LakeFort NelsonPeace River NorthPeace River SouthNechakoTerracePrince RupertSmithersQuesnelPrince GeorgeKitimat10610796106107121113951018471928 81381331208885907 992739 81179 71059810795105908657837 8818 7668076827 7861036266766186777273687 485928 7969 8112104959 98371959 41041029370727 76880648 71068895909 89010189866083837 9856976758 7831107247546756827 4717 87 48622%15%10%9%9%8%8%0%0%0%0%-3%-6%29%27%25%23%17%16%14%14%13%12%10%10%10%9%9%5%4%0%0%0%0%0%0%0%0%0%0%0%-7%-24%36%28%21%12%9%5%0%0%-7%-8%-14%Agassiz–HarrisonHopeSouth Surrey–White RockMissionLangleyMaple RidgeChilliwackNew WestminsterDeltaAbbotsfordSurreyCoquitlamBurnabyPowell RiverVancouver City CentreSunshine CoastWest Van.–Bowen IslandVancouver WestsideVan. Downtown EastsideNorth VancouverHowe SoundRichmondVancouver MidtownVancouver SouthVancouver North East921171188 881868 48 9828069666612010310811185918260636259546496108827683838 98 48 47 77581938 792104818 786687575807636%20%9%7%6%3%0%0%-3%-6%-10%-12%-21%26%17%16%6%5%5%-5%-13%-17%-19%-30%-33%3.4 Neurological: Benzodiazepines and related drugsU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 1 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.4G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.4h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson962194228 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita1361266234Users per 1,000962194228Days per user171736315Cost per day45151252t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 1 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 3.4C» Variation in days of treatment per user by local health area, 2006Regional variations in days of treatmentAfter we accounted for differences in population age, sex, and health status, there was modest variation across BC’s LHAs in the average number of days of treatment received per user of benzodiazepines or related drugs in 2006.In all but two LHAs (Howe Sound and Fort Nelson), the average number of days benzodiazepine or related therapy received per user was over 100.Because durations of benzodiazepine use across LHAs are above recommended levels, even LHAs where durations are lower than predicted based on provincial averages for populations of the same age, sex, and health status may still exceed appropriate levels of benzodiazepine use. (See Appendix C on rates of long-term use.)AlberniLake CowichanGreater VictoriaNanaimoQualicumCampbell RiverGulf IslandsSaanichLadysmithSookeCowichanCourtenayIsland NorthKeremeosPrincetonPentictonKamloopsSouth OkanaganCariboo–ChilcotinSalmon Arm100 Mile HouseGrand ForksCranbrookCentral OkanaganRevelstokeGoldenWindermereSouth CaribooTrailSummerlandVernonEnderbyCrestonKootenay LakeCastlegarArrow LakesKettle ValleyLillooetKimberleyMerrittArmstrongNelsonNorth ThompsonBurns LakePeace River SouthFort NelsonQuesnelTerracePeace River NorthNechakoPrince GeorgeKitimatSmithersPrince Rupert15%11%7%6%4%0%0%0%0%0%-5%-11%-12%24%21%14%12%11%11%11%9%9%8%2%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-11%-18%-20%17%16%0%0%-8%-10%-12%-14%-14%-15%-17%HopeNew WestminsterChilliwackMaple RidgeLangleySouth Surrey–White RockAgassiz–HarrisonMissionSurreyAbbotsfordDeltaBurnabyCoquitlamPowell RiverVan. Downtown EastsideVancouver City CentreSunshine CoastRichmondNorth VancouverVancouver WestsideWest Van.–Bowen IslandVancouver MidtownVancouver SouthVancouver North EastHowe Sound13%11%9%7%5%3%0%0%-3%-4%-5%-6%-7%21%15%4%0%-5%-7%-7%-10%-10%-12%-13%-27%3.4 Neurological: Benzodiazepines and related drugs1681581581531671361491531571341391331211951831751551751461641611651541501221391391571451621521541641191381531391211521531311141121651549613912310511511611311511314414214814 416113915515715313614614813615414815213815713114814 815114214713113513714914 4160150153157136145150146141152151146137137139131991391341171301341311341341671621611481461671401321321391361401271781581401441391351331451231331279614714514713813916113513413714 414314813714 4136134150145144143159136149145125U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 1 7Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.4G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.4i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson1717-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%36315Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita1361266234Users per 1,000962194228Days per user171736315Cost per day45151252t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 1 8Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.4d» Variation in cost of treatment per day by local health area, 2006Regional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, there was moderate variation in the average cost per day of therapy received among users of benzodiazepines or related drugs across BC’s LHAs in 2006.The average costs per day of benzodiazepines and related treatments in Vancouver Downtown Eastside, Sunshine Coast, and several Interior LHA’s were much higher than levels predicted based on provincial averages for populations of the same age, sex, and health status were. Supplemental data (available online) show that, unlike most other therapeutic categories, regional variations in dispensing fees paid per day of treatment received were far greater than regional variations in the costs of the benzodiazepines or related drugs themselves.Lake CowichanCampbell RiverIsland NorthCourtenayCowichanGreater VictoriaNanaimoLadysmithQualicumSookeSaanichGulf IslandsAlberniSalmon ArmPrincetonCrestonSummerlandLillooetEnderbySouth OkanaganPentictonMerrittCariboo–ChilcotinCranbrookKimberley100 Mile HouseCentral OkanaganWindermereKootenay LakeNelsonCastlegarArrow LakesTrailGrand ForksKettle ValleyKeremeosGoldenRevelstokeArmstrongVernonKamloopsNorth ThompsonSouth CaribooPrince RupertTerraceQuesnelSmithersBurns LakeNechakoPeace River NorthKitimatFort NelsonPeace River SouthPrince George$0.68$0.67$0.68$0.64$0.60$0.59$0.60$0.56$0.55$0.58$0.50$0.50$0.52$0.73$0.72$0.65$0.66$0.67$0.66$0.64$0.65$0.66$0.66$0.63$0.61$0.62$0.60$0.57$0.52$0.57$0.55$0.56$0.59$0.60$0.54$0.55$0.62$0.57$0.56$0.58$0.59$0.62$0.59$0.64$0.64$0.61$0.59$0.58$0.59$0.63$0.62$0.64$0.57$0.58$0.59$0.60$0.62$0.59$0.58$0.58$0.59$0.55$0.55$0.60$0.55$0.56$0.58$0.57$0.57$0.55$0.57$0.58$0.58$0.56$0.57$0.60$0.61$0.59$0.57$0.59$0.58$0.56$0.55$0.58$0.58$0.56$0.58$0.57$0.56$0.56$0.62$0.59$0.56$0.58$0.58$0.58$0.56$0.60$0.61$0.60$0.61$0.58$0.59$0.63$0.61$0.64$0.60$0.6113%12%9%8%4%2%2%0%0%-2%-9%-10%-11%26%23%17%16%16%14%13%12%11%8%7%7%5%3%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%7%4%0%0%0%0%0%0%0%-5%-6%Agassiz–HarrisonHopeNew WestminsterCoquitlamMissionLangleyChilliwackMaple RidgeSurreyBurnabyDeltaAbbotsfordSouth Surrey–White RockVan. Downtown EastsideSunshine CoastPowell RiverHowe SoundVancouver City CentreVancouver MidtownVancouver WestsideWest Van.–Bowen IslandVancouver North EastVancouver SouthNorth VancouverRichmond$0.61$0.56$0.60$0.58$0.60$0.56$0.56$0.58$0.58$0.54$0.55$0.53$0.51$0.86$0.67$0.64$0.67$0.62$0.61$0.58$0.52$0.54$0.53$0.54$0.51$0.55$0.58$0.59$0.60$0.62$0.58$0.58$0.61$0.61$0.58$0.59$0.57$0.56$0.62$0.57$0.59$0.63$0.60$0.60$0.57$0.55$0.58$0.57$0.58$0.5711%0%0%-3%-3%-3%-3%-5%-5%-6%-6%-8%-9%32%17%9%7%4%2%2%-5%-7%-8%-8%-11%3.4 Neurological: Benzodiazepines and related drugsU B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 1 9Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.4G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.4J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson451512-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%52Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita1361266234Users per 1,000962194228Days per user171736315Cost per day45151252t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 2 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 3.4e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20063.4 Neurological: Benzodiazepines and related drugsSources of spending deviationAfter we accounted for differences in population age, sex, and health status, variations across BC’s LHAs in spending per capita on benzodiazepines or related drugs resulted from the combined effects of variations in number of users per 1,000 residents and variations in the number of days of therapy received per user.AlberniNanaimoCampbell RiverGreater VictoriaQualicumGulf IslandsSaanichLake CowichanLadysmithCowichanIsland NorthSookeCourtenayPrincetonPentictonKeremeosCariboo–ChilcotinRevelstokeCranbrookSalmon ArmGoldenKamloopsSouth OkanaganSouth CaribooSummerland100 Mile HouseEnderbyCrestonLillooetCastlegarNorth ThompsonTrailCentral OkanaganWindermereKootenay LakeArrow LakesKettle ValleyKimberleyArmstrongVernonNelsonGrand ForksMerrittBurns LakePeace River NorthPeace River SouthNechakoPrince RupertFort NelsonTerraceSmithersQuesnelPrince GeorgeKitimatAgassiz–HarrisonHopeLangleyMissionChilliwackMaple RidgeNew WestminsterSouth Surrey–White RockDeltaAbbotsfordSurreyCoquitlamBurnabyPowell RiverVancouver City CentreSunshine CoastVan. Downtown EastsideWest Van.–Bowen IslandVancouver WestsideNorth VancouverHowe SoundRichmondVancouver MidtownVancouver SouthVancouver North East42%24%7%5%4%4%3%0%-5%-9%-12%-13%-23%31%20%19%11%5%0%-7%-16%-19%-22%-33%-37%0%13%5%0%9%7%11%3%-5%-4%-3%-7%-6%21%4%0%15%-10%-7%-7%-27%-5%-10%-12%-13%11%0%-3%-3%-3%-5%0%-9%-6%-8%-5%-3%-6%9%4%17%32%-5%2%-8%7%-11%2%-8%-7%36%20%6%7%0%3%0%9%-3%-6%-10%-12%-21%26%17%16%5%6%5%-5%-13%-17%-19%-30%-33%25%16%12%11%10%8%7%5%5%0%0%0%-8%34%34%33%23%21%21%20%19%18%15%14%13%10%4%4%0%0%0%0%0%0%0%0%0%0%0%0%-2%-3%-21%44%20%16%8%0%0%0%-1%-5%-11%-19%15%6%0%7%4%0%0%11%0%-5%-12%0%-11%21%14%24%11%0%8%11%0%12%11%0%0%9%0%0%0%0%-20%0%2%0%0%0%0%0%-11%0%-18%9%0%17%-10%16%-12%-17%0%-8%-15%0%-14%-14%22%15%10%9%8%9%8%0%0%-3%0%0%-6%27%29%25%17%23%16%12%14%14%10%10%9%5%0%0%0%0%0%9%10%13%0%0%0%-7%0%4%0%0%-24%36%21%12%9%0%28%5%0%-7%-8%-14%-11%2%12%2%0%-10%-9%13%0%4%9%-2%8%23%12%0%8%0%7%26%0%0%13%0%16%5%14%17%16%0%0%0%3%0%0%0%0%7%0%0%0%0%11%0%0%-5%0%7%0%4%0%0%-6%0%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 2 1Neurological drugsCholinesterase inhibitors3.5t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 2 2IntroductionNumberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$40$30$20$100-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population40302010Private spendingPublic spending0 0 0 0 0 021234100%100%100%$0.00 $0.00 $0.01 $0.03 $0.21$1.78$43.36100%100%100%$0.00100% private100% privateUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publicly$14.50figure 3.5d» Spending per capita in BC, by age group and source of finance, 2006figure 3.5B» Percentage of spending within category by specific drug types, 2006figure 3.5C» Percentage of drug types within category covered by BC PharmaCare, 2006figure 3.5a» Spending within category relative to spending on all prescription drugs, 2006Rivastigmine 9%Galantamine 25%Donepezil 66%Total drug spendingper capitaSpending per capita on cholinesterase inhibitors$3 $410RivastigimineGalantamineDonepezil9%25%66%Listing status as of December 2006Not covered100%Common goal of therapyReduce symptons of dementia•	Examples of indicated conditionsAlzheimer’s disease•	Rivastigmine 9%Galantamine 25%Donepezil 66%Total drug spendingper capitaSpending per capita on cholinesterase inhibitors$3 $410RivastigimineGalantamineDonepezil9%25%66%Listing status as of December 2006Not covered100%3.5  Neurological: Cholinesterase inhibitorsTotal spending in BC: $12-millionSpending per capita in BC: $3.04Dispensing fees as percent of spending: 6%Users of treatment per 1,000 pop. in BC: 0Spending per user of treatment in BC: $1,256.32Days of treatment per user in BC: 256Cost of treatment per day in BC: $4.90U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 2 3figure 3.5e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $12 million, or $3.04 per capita, on cholinesterase inhibitors in 2006. While this was the least frequently used therapeutic category studied, it was the most expensive in terms of spending per user of medicines ($1,256.32).Fewer than one in 1,000 BC residents filled a pre-scription for cholinesterase inhibitors in 2006. Users received an average of 256 days of treatment, indicat-ing that most users took these medicines relatively persistently throughout the year.The average cost per day of these treatments was $4.90 (the second highest of all categories studied).Leading drugs in classDonepezil accounted for two-thirds of spending in this category, and Galantamine accounted for 25%. Provincial formulary coverageBC PharmaCare did not cover any cholinesterase inhibitors in 2006.Spending and use by ageSpending on and use of cholinesterase inhibitors was extremely concentrated among the very elderly in 2006.Average spending per capita on cholinesterase inhibi-tors was negligible for BC residents under age 60.While average spending per person in the cohort of residents aged 60–69 was less than $2, average spending per person aged 70–79 was $14.50 and spending per person aged 80 and older was $43.36.None of the spending in this category was financed by PharmaCare; it was all financed privately (through private insurance or out of pocket).The numbers of cholinesterase inhibitor users per 1,000 people by age group mirror the age distribution of spending in this category. Two-thirds of users of these medicines were aged 80 and older.Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$40$30$20$100-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population40302010Private spendingPublic spending0 0 0 0 0 021234100%100%100%$0.00 $0.00 $0.01 $0.03 $0.21$1.78$43.36100%100%100%$0.00100% private100% privateUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publicly$14.50t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 2 4Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 3.5a» Variation in spending per capita by local health area, 20063.5  Neurological: Cholinesterase inhibitorsRegional variations in spending per capitaAfter we accounted for differences in population age, sex, and health status, spending per capita on cholinesterase inhibitors across BC’s LHAs in 2006 was marked by relatively few extremes. However, these extremes made regional variations in spending from this category among the highest of all therapeutic categories studied.Spending per capita on cholinesterase inhibitors in eight LHAs—including Vancouver Midtown, Vancou-ver North East, and Vancouver Downtown Eastside—was lower than predicted based on provincial averages for populations of the same age, sex, and health status.Spending on cholinesterase inhibitors in Coquitlam, South Surrey/White Rock, and Saanich was higher than levels predicted based on provincial averages.SaanichGreater VictoriaSookeGulf IslandsCowichanLake CowichanLadysmithNanaimoQualicumAlberniCourtenayCampbell RiverIsland NorthKimberleyWindermereCrestonKootenay LakeNelsonArrow LakesTrailGrand ForksSouth OkanaganPentictonKeremeosPrincetonGoldenRevelstokeSalmon ArmArmstrong VernonCentral OkanaganKamloops100 Mile HouseNorth ThompsonCariboo–ChilcotinLillooetSouth CaribooEnderbyCastlegarSummerlandMerrittKettle ValleyCranbrookPrince RupertSmithersBurns LakeNechakoPrince GeorgePeace River SouthKitimatFort NelsonTerracePeace River NorthQuesnel$6.5$5.4$1.7$ 4. 7$3.8$ 4.6$ 4.1$3.6$5.5$3.1$3.3$2.5$1.3$4.5$1.3$2.6$1.2$2.0$3.9$ 4.6$3.5$4.3$ 4.2$3.6$0.9$0.5$3.1$3.0$2.5$3.7$3.5$2.9$1.6$0.5$1.1$0.7$2.5$5.8$2.8$ 4.3$3.2$1.2$1.3$0.5$2.1$1.9$1.2$1.9$1.0$1.5$1.3$0.6$0.9$0.8$5.3$5.1$2.4$ 4. 8$3.9$3.6$4. 4$3.7$6.2$3.3$4.5$2.5$1.6$4.3$1.9$ 4.5$1.8$2.3$4.3$ 4.0$ 4.2$5.5$4. 9$3.6$1.7$1.9$2.6$3.3$2.9$3.0$3.8$2.9$2.3$3.0$1.5$3.5$2.5$4.1$3.0$5.3$4.5$2.0$2.3$1.3$1.9$2.3$1.9$1.9$1.6$1.6$0.4$1.7$1.2$1.421%5%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-6%-21%-33%-46%-59%0%0%0%0%0%0%0%0%0%-28%-61%CoquitlamSouth Surrey–White RockHopeChilliwackAbbotsfordLangleyDeltaNew WestminsterBurnabyMaple RidgeMissionAgassiz–HarrisonSurreyNorth VancouverRichmondWest Van.–Bowen IslandSunshine CoastPowell RiverHowe SoundVancouver WestsideVancouver SouthVancouver City CentreVancouver MidtownVancouver North EastVan. Downtown Eastside$2.3$6.6$4.0$2.8$2.3$2.9$3.1$3.5$2.9$2.6$2.4$2.5$2.1$3.5$2.2$6.4$ 4.2$3.2$1.1$5.1$2.5$3.9$1.7$1.8$1.5$1.8$5.5$3.4$2.6$2.6$2.7$2.8$2.9$2.8$2.4$2.2$2.1$1.7$3.4$2.2$5.4$ 4. 8$3.5$1.5$3.7$2.8$ 4.3$2.3$2.6$3.221%20%0%0%0%0%0%0%0%0%0%0%0%1%0%0%0%0%0%0%0%-11%-27%-35%-74%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 2 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.5G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.5f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson32-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%6518Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita326518Users per 1,00072221254Days per user1426633Cost per day703411t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 2 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.5B» Variation in users of treatment per 1,000 residents by local health area, 20063.5  Neurological: Cholinesterase inhibitorsRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status, the use of cholinesterase inhibi-tors was more highly varied across BC’s LHAs in 2006 than any other therapeutic category studied.The use of cholinesterase inhibitors in some of the most affluent LHAs in the province—such as Van-couver Westside, West Vancouver–Bowen Island, and South Surrey/White Rock—was well above rates predicted based on provincial averages for populations of the same age, sex, and health status.Use of cholinesterase inhibitors was below rates predicted based on provincial averages in a few major population centres—including Vancouver City Centre, Vancouver Midtown, Vancouver North East, and Vancouver Downtown Eastside.SaanichGreater VictoriaGulf IslandsCowichanLake CowichanLadysmithNanaimoQualicumAlberniCampbell RiverIsland NorthCourtenaySookeVernonKimberleyWindermereKootenay LakeNelsonArrow LakesTrailGrand ForksPentictonKeremeosPrincetonRevelstokeSalmon ArmArmstrongCentral OkanaganKamloops100 Mile HouseCariboo–ChilcotinLillooetSouth CaribooEnderbyCastlegarSummerlandMerrittKettle ValleySouth OkanaganCrestonCranbrookGoldenNorth ThompsonFort NelsonSmithersBurns LakeNechakoPrince GeorgeKitimatPeace River NorthPeace River SouthQuesnelPrince RupertTerrace65545546332424522245443234343210364523532002231221111155544546432533433345454334343323344644653221232222222219%0%0%0%0%0%0%0%0%0%0%-29%-36%22%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-24%-53%-55%-142%-187%99%0%0%0%0%0%0%-49%-56%-96%-110%South Surrey–White RockNew WestminsterCoquitlamSurreyHopeChilliwackLangleyDeltaBurnabyMaple RidgeMissionAgassiz–HarrisonAbbotsfordVancouver WestsideWest Van.–Bowen IslandNorth VancouverRichmondSunshine CoastPowell RiverHowe SoundVancouver SouthVancouver City CentreVancouver MidtownVancouver North EastVan. Downtown Eastside8423433433333573244133222632243333333346424423433423%20%19%18%0%0%0%0%0%0%0%0%-12%32%17%0%0%0%0%0%0%-12%-23%-32%-69%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 2 7Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.5G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.5h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson722212-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%54Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita326518Users per 1,00072221254Days per user1426633Cost per day703411t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 2 8Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 3.5C» Variation in days of treatment per user by local health area, 20063.5  Neurological: Cholinesterase inhibitorsRegional variations in days of treatmentAfter we accounted for differences in population age, sex, and health status, there was little variation in the average number of days of treatment received per user of cholinesterase inhibitors across BC’s LHAs in 2006.In most LHAs, there wasn’t a statistically significant difference between the actual number of days of cholinesterase inhibitor treatment received per user and the level predicted based on provincial averages for populations of the same age, sex, and health status.NanaimoGreater VictoriaSaanichGulf IslandsCowichanLake CowichanLadysmithQualicumAlberniCampbell RiverIsland NorthCourtenaySookeMerrittVernonKimberleyWindermereKootenay LakeNelsonArrow LakesTrailGrand ForksPentictonKeremeosPrincetonRevelstokeArmstrong Kamloops100 Mile HouseCariboo–ChilcotinLillooetSouth CaribooEnderbyKettle ValleySouth OkanaganCrestonGoldenNorth ThompsonCentral OkanaganSalmon ArmCranbrookSummerlandCastlegarFort NelsonSmithersBurns LakeNechakoPrince GeorgeKitimatPeace River SouthPrince RupertTerracePeace River NorthQuesnel7%6%0%0%0%0%0%0%0%0%0%0%0%27%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-5%-16%-25%-27%-31%0%0%0%0%0%0%0%0%0%-25%-43%South Surrey–White RockNew WestminsterCoquitlamSurreyHopeChilliwackLangleyDeltaBurnabyMaple RidgeMissionAgassiz–HarrisonAbbotsfordVancouver City CentreNorth VancouverVancouver WestsideWest Van.–Bowen IslandRichmondSunshine CoastPowell RiverHowe SoundVancouver SouthVan. Downtown EastsideVancouver North EastVancouver Midtown0%0%0%0%0%0%0%0%0%0%0%0%0%11%11%0%0%0%0%0%0%0%0%-9%-12%27527427325426526225424425822724024825833124526022016523229922925025025912830321025222027536424928116223523936336424221819919518722327930528025820524118323920216425525925826025025225525025625026825225825325726125626426225425825925826922925726125924726526727425626125825426525225625725725625425326626525925325525126125926025226125126724624425826925925825126824224828 9283266251263266251296244234231230256258256253253257258256256251254276256259254260255258256262251257256253259U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 2 9Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.5G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.5i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson142-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%6633Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita326518Users per 1,00072221254Days per user1426633Cost per day703411t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 3 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.5d» Variation in cost of treatment per day by local health area, 20063.5  Neurological: Cholinesterase inhibitorsRegional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, there was very little varia-tion in the average cost per day of therapy received among users of cholinesterase inhibitors across BC’s LHAs in 2006.In most LHAs, there wasn’t a statistically significant difference between the actual cost per day of cho-linesterase inhibitor treatment received and the cost predicted based on provincial averages for popula-tions of the same age, sex, and health status.SaanichGreater VictoriaSookeGulf IslandsCowichanLake CowichanLadysmithQualicumAlberniCourtenayCampbell RiverVancouver IslandNanaimoMerrittSummerlandCranbrookKimberleyWindermereCrestonKootenay LakeNelsonCastlegarArrow LakesTrailGrand ForksKettle ValleySouth OkanaganPentictonKeremeosPrincetonGoldenRevelstokeSalmon ArmArmstrongVernonCentral OkanaganKamloops100 Mile HouseNorth ThompsonCariboo–ChilcotinLillooetSouth CaribooEnderbyKitimatQuesnelPrince RupertSmithersNechakoPrince GeorgePeace River SouthPeace River NorthFort NelsonTerraceBurns Lake$5.12$5.04$5.04$ 4. 91$5.04$ 4. 93$ 4.61$5.05$4.67$ 4. 92$ 4. 90$ 4. 9 8$ 4.60$5.59$5.27$ 4. 9 9$ 4. 9 7$ 4. 8 9$5.20$4. 45$ 4. 80$ 4. 9 8$ 4.61$4. 91$5.13$3.86$5.05$4.9 9$5.05$5.34$ 4.60$4. 92$5.15$5.40$ 4. 86$ 4. 96$5.00$4.93$6.25$4.91$5.7 7$ 4. 96$ 4. 83$5.83$5.20$5.17$ 4. 9 9$ 4. 45$5.01$4.4 8$5.17$5.17$5.07$3.27$ 4. 90$ 4. 8 8$ 4. 90$ 4. 92$ 4. 91$ 4. 9 4$ 4. 8 9$ 4. 91$ 4. 90$ 4. 91$ 4. 90$ 4. 8 9$ 4. 90$ 4. 95$ 4. 92$ 4. 90$ 4. 91$ 4. 9 4$ 4. 91$ 4. 91$ 4. 90$ 4. 91$ 4. 91$ 4. 90$ 4. 95$ 4. 91$ 4. 91$ 4. 91$ 4. 91$ 4. 90$ 4. 9 4$ 4. 92$ 4. 90$ 4. 91$ 4. 91$ 4. 91$ 4. 90$ 4. 92$ 4. 86$ 4. 91$ 4. 8 7$ 4. 8 8$ 4. 90$ 4. 90$ 4. 9 4$ 4. 8 7$ 4. 8 8$ 4. 90$ 4. 9 4$ 4. 93$ 4. 92$ 4. 93$ 4. 96$ 4. 914%3%0%0%0%0%0%0%0%0%0%0%-6%12%7%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%17%0%0%0%0%0%0%0%0%0%-41%HopeChilliwackAbbotsfordLangleyDeltaNew WestminsterBurnabyMaple RidgeCoquitlamMissionAgassiz–HarrisonSurreySouth Surrey–White RockSunshine CoastWest Van.–Bowen IslandRichmondNorth VancouverPowell RiverHowe SoundVancouver City CentreVancouver North EastVancouver WestsideVancouver SouthVan. Downtown EastsideVancouver Midtown$5.12$4.96$ 4. 9 4$ 4. 8 8$ 4. 8 4$ 4. 9 9$ 4. 95$5.05$4.9 9$ 4. 80$ 4.60$4. 91$ 4.29$5.36$5.04$ 4. 85$ 4. 8 9$ 4.67$ 4. 90$ 4. 7 9$ 4. 75$ 4. 95$ 4. 7 8$ 4.61$4.60$4. 90$ 4. 92$ 4. 91$ 4. 90$ 4. 8 9$ 4. 8 9$ 4. 8 8$ 4. 92$ 4. 90$ 4. 92$ 4. 91$ 4. 92$ 4. 8 9$ 4. 90$ 4. 8 8$ 4. 90$ 4. 90$ 4. 8 8$ 4. 92$ 4. 8 8$ 4. 90$ 4. 8 8$ 4. 8 9$ 4. 8 8$ 4. 8 80%0%0%0%0%0%0%0%0%0%0%0%-13%9%3%0%0%0%0%0%0%0%0%-6%-6%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 3 1Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.5G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.5J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson7034-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%11Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita326518Users per 1,00072221254Days per user1426633Cost per day703411t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 3 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 3.5e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20063.5  Neurological: Cholinesterase inhibitorsSources of spending deviationAfter we accounted for differences in population age, sex, and health status, variations across BC’s LHAs in spending per capita on cholinesterase inhibitors in 2006 were primarily driven by varia-tions in the number of users of these medicines per 1,000 residents.Some LHAs where use differed significantly from rates predicted based on provincial averages for populations of the same age, sex, and health status did not have statistically significant differences in spending. This is largely because our methods for estimating spending per capita involve an adjust-ment for selection bias that reduces confidence intervals for estimates from that model.SaanichGreater VictoriaGulf IslandsCowichanLake CowichanLadysmithQualicumAlberniCampbell RiverIsland NorthCourtenaySookeNanaimo100 Mile HouseVernonKimberleyWindermereKootenay LakeNelsonArrow LakesTrailGrand ForksPentictonKeremeosPrincetonRevelstokeArmstrong KamloopsCariboo–ChilcotinLillooetSouth CaribooEnderbySouth OkanaganCrestonGoldenNorth ThompsonCentral OkanaganSalmon ArmCastlegarSummerlandMerrittKettle ValleyCranbrookFort NelsonSmithersBurns LakeNechakoPrince GeorgeKitimatPeace River SouthPrince RupertTerracePeace River NorthQuesnelCoquitlamSouth Surrey–White RockNew WestminsterSurreyHopeChilliwackLangleyDeltaBurnabyMaple RidgeMissionAgassiz–HarrisonAbbotsfordNorth VancouverPowell RiverSunshine CoastVancouver WestsideWest Van.–Bowen IslandRichmondHowe SoundVancouver SouthVancouver City CentreVancouver MidtownVancouver North EastVan. Downtown Eastside21%20%0%0%0%0%0%0%0%0%0%0%0%1%0%0%0%0%0%0%0%-11%-27%-35%-74%0%0%0%0%0%0%0%0%0%0%0%0%0%11%0%0%0%0%0%0%0%11%-12%-9%0%0%-13%0%0%0%0%0%0%0%0%0%0%0%0%0%9%0%3%0%0%0%0%-6%0%-6%19%23%20%18%0%0%0%0%0%0%0%0%-12%0%0%0%32%17%0%0%0%-12%-23%-32%-69%21%5%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-6%-21%-33%-46%-59%0%0%0%0%0%0%0%0%0%-28%-61%0%6%0%0%0%0%0%0%0%0%0%0%7%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-5%-16%-31%-27%27%0%-25%0%0%0%0%0%0%0%0%0%-25%-43%19%0%0%0%0%0%0%0%0%0%-29%-36%0%0%22%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-24%-53%-142%-187%0%0%0%0%0%0%-55%99%0%0%0%0%0%-49%-96%-110%0%-56%4%3%0%0%0%0%0%0%0%0%0%0%-6%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%7%12%0%0%0%0%-41%0%0%17%0%0%0%0%0%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 3 3Neurological drugsDrugs for Parkinson’s disease3.6t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 3 4Introductionfigure 3.6d» Spending per capita in BC, by age group and source of finance, 2006figure 3.6C» Percentage of drug types within category covered by BC PharmaCare, 2006figure 3.6B» Percentage of spending within category by specific drug types, 2006figure 3.6a» Spending within category relative to spending on all prescription drugs, 2006Others 10%Pergolide 7%Ropinirole 9%Pramipexole 18%Levodopa and decarboxylase inhibitor 56%Total drug spendingper capitaSpending per capita on drugs for Parkinson’s disease$3 $410OthersPergolideRopinirolePramipexoleLevodopa and decarboxylaseinhibitors10%7%9%18%56%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered30%20%50%Common goal of therapyReduce symptoms of Parkinson’s disease•	Examples of indicated conditionsParkinson’s disease•	Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$20$15$10$50-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population2015105$0.01 $0.02 $0.04 $0.13$0.67$2.60$7.24$15.80$16.4834%66%36%64%52%48%64%36%59% private;41% public53% private;47% public34% private;66% public64% private;36% public62% private;38% public70% private;30% public75% private;25% public60% private;40% public68% private;32% public74% private;26% publicPrivate spendingPublic spending0 0 01236141828%72%35%65%58%42%74%26%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyOthers 10%Pergolide 7%Ropinirole 9%Pramipexole 18%Levodopa and decarboxylase inhibitor 56%Total drug spendingper capitaSpending per capita on drugs for Parkinson’s disease$3 $410OthersPergolideRopinirolePramipexoleLevodopa and decarboxylaseinhibitors10%7%9%18%56%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered30%20%50%3.6  Neurological: Drugs for Parkinson’s diseaseTotal spending in BC: $12-millionSpending per capita in BC: $2.96Dispensing fees as percent of spending: 7%Users of treatment per 1,000 pop. in BC: 3Spending per user of treatment in BC: $905.06Days of treatment per user in BC: 312Cost of treatment per day in BC: $2.90U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 3 5figure 3.6e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $12 million, or $2.96 per capita, on Parkinson’s drugs in 2006. The average cost per day of Parkinson’s treatment ($2.90) was the fourth highest among therapeutic categories studied.While only three in 1,000 BC residents filled a pre-scription for Parkinson’s treatments in 2006, users of these therapies received an average of 312 days of therapy in the year, indicating that the average patient was taking Parkinson’s medications persistently.Leading drugs in classProducts with levodopa and carbidopa in combination accounted for 56% of spending on Parkinson’s treat-ments; dopamine agonists (pramipexole, ropinirole, and pergolide) accounted for 34% of spending.Provincial formulary coverageBC PharmaCare covered eight of the 10 types of Parkinson’s drug sold in Canada in 2006.Spending and use by ageSpending on Parkinson’s drugs was highly concentrated among elderly residents. About 82% of total spending in this category was for persons aged 60 and older. Average spending per capita was negligible in age groups under age 40, but increased rapidly to more than $15 per person aged 70 and older. BC PharmaC-are financed a majority of overall spending on Parkin-son’s drugs for the age groups 70–79 and 80 and older.Use of Parkinson’s drugs was extremely rare (less than one person in 1,000) for BC residents under age 40. Rates of use approximately doubled with each 10-year age group thereafter: from 2.6 persons per 1,000 residents aged 50–59 to 19.5 per 1,000 residents aged 80 and older.PharmaCare paid for at least 50% of costs for a majority of Parkinson’s drug users who were aged 70 and older. Most users in other age groups paid for most of their Parkinson’s drugs through private means (insurance or out of pocket).Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita$20$15$10$50-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population2015105$0.01 $0.02 $0.04 $0.13$0.67$2.60$7.24$15.80$16.4834%66%36%64%52%48%64%36%59% private;41% public53% private;47% public34% private;66% public64% private;36% public62% private;38% public70% private;30% public75% private;25% public60% private;40% public68% private;32% public74% private;26% publicPrivate spendingPublic spending0 0 01236141828%72%35%65%58%42%74%26%Users for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publiclyt h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 3 6Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 3.6a» Variation in spending per capita by local health area, 20063.6  Neurological: Drugs for Parkinson’s diseaseRegional variations in spending per capitaAfter we accounted for differences in population age, sex, and health status, spending on Parkinson’s drugs across BC’s LHAs in 2006 was marked by relatively few extremes and a large number of regions at or near the provincial average.In 62 LHAs, spending per capita on Parkinson’s drugs was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.There were outlying LHAs in all health authorities except Fraser.Greater VictoriaSaanichSookeGulf IslandsCowichanLake CowichanNanaimoAlberniCourtenayCampbell RiverIsland NorthQualicumLadysmithMerritt100 Mile HouseTrailKimberleyWindermereCrestonKootenay LakeNelsonCastlegarArrow LakesGrand ForksSouth OkanaganPentictonKeremeosPrincetonRevelstokeSalmon ArmArmstrongVernonCentral OkanaganKamloopsNorth ThompsonCariboo–ChilcotinLillooetSouth CaribooSummerlandEnderbyCranbrookGoldenKettle ValleyPeace River NorthKitimatQuesnelPrince RupertSmithersBurns LakePeace River SouthFort NelsonTerraceNechakoPrince George$4.0$5.2$2.3$4.2$2.8$ 4.0$2.9$2.9$3.3$2.6$1.4$5.0$3.7$2.8$ 4.1$3.2$2.2$2.6$5.2$3.2$2.7$3.8$1.6$3.2$6.1$6.0$1.4$ 9.0$1.8$3.8$ 4. 9$ 4.1$3.4$3.7$0.8$2.4$0.6$2.9$5.9$6.7$1.4$1.0$1.7$1.8$2.2$1.4$1.4$2.6$2.2$1.4$0.1$1.2$1.4$1.8$3.6$4. 8$2.4$3.8$2.8$2.8$3.2$3.1$3.3$2.7$1.3$5.8$ 4.6$1.5$3.4$2.8$1.6$2.9$ 4.1$2.8$2.0$3.2$1.6$2.8$ 4. 7$ 4.6$2.2$5.7$2.0$3.4$3.6$3.8$3.3$3.2$0.9$1.7$1.0$3.6$4.6$5.4$1.5$1.5$3.2$1.4$2.2$1.6$1.9$2.1$1.9$1.2$0.2$1.8$1.5$2.011%8%0%0%0%0%0%0%0%0%0%-14%-20%66%20%16%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-5%-37%-64%25%1%0%0%0%0%0%0%0%-5%-9%AbbotsfordSouth Surrey–White RockHopeChilliwackLangleyDeltaNew WestminsterBurnabyCoquitlamMissionAgassiz–HarrisonSurreyMaple RidgeVancouver MidtownVancouver North EastRichmondWest Van.–Bowen IslandSunshine CoastPowell RiverHowe SoundVancouver City CentreVancouver SouthVancouver WestsideNorth VancouverVan. Downtown Eastside$3.0$5.0$3.1$2.6$2.5$2.7$2.3$3.1$2.2$2.8$0.7$1.9$2.7$2.4$2.1$2.4$ 4.3$3.6$4.6$1.5$2.9$2.8$3.7$3.4$3.1$2.8$ 4. 8$2.9$2.4$2.4$2.9$2.7$3.5$2.5$2.7$0.9$2.1$2.8$1.9$1.8$2.7$5.5$3.6$3.5$2.1$3.1$2.9$ 4.0$3.7$3.67%4%0%0%0%0%0%0%0%0%0%0%-3%23%16%0%0%0%0%0%0%-2%-6%-8%-15%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 3 7Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.6G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.6f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson535-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%11262Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita53511262Users per 1,000310365349Days per user1552165Cost per day16128310282t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 3 8Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.6B» Variation in users of treatment per 1,000 residents by local health area, 20063.6  Neurological: Drugs for Parkinson’s diseaseRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status, there were significant variations across BC’s LHAs in the number of Parkinson’s drug users per 1,000 residents in 2006. These variations were most extreme across Vancouver Coastal LHAs. The use of Parkinson’s drugs in several Interior LHAs was well above rates predicted based on provincial averages for populations of the same age, sex, and health status.Parkinson’s drug use in several Fraser LHAs was lower than rates predicted based on provincial averages.Greater VictoriaSaanichSookeGulf IslandsCowichanLake CowichanAlberniCourtenayCampbell RiverIsland NorthLadysmithNanaimoQualicumMerrittPrincetonArmstrongSouth OkanaganPentictonCariboo–ChilcotinSummerlandCrestonNelsonKamloops100 Mile HouseTrailKimberleyWindermereKootenay LakeCastlegarArrow LakesGrand ForksKeremeosRevelstokeSalmon ArmVernonCentral OkanaganNorth ThompsonLillooetSouth CaribooEnderbyCranbrookGoldenKettle ValleyPeace River NorthKitimatQuesnelPrince RupertSmithersBurns LakePeace River SouthFort NelsonNechakoPrince GeorgeTerrace4535453432535775753653444324444324442235321332234203224534433432546354542443334333334434442344333233323213338%0%0%0%0%0%0%0%0%0%0%-11%-19%81%37%30%28%27%26%23%22%19%13%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%28%0%0%0%0%0%0%0%0%0%-44%AbbotsfordSouth Surrey–White RockHopeChilliwackLangleyMissionAgassiz–HarrisonMaple RidgeSurreyDeltaCoquitlamBurnabyNew WestminsterVancouver MidtownVancouver North EastPowell RiverVancouver SouthSunshine CoastVan. Downtown EastsideVancouver City CentreRichmondVancouver WestsideNorth VancouverWest Van.–Bowen IslandHowe Sound355333222323344544333334135433323332333343433333520%0%0%0%0%0%0%0%-11%-12%-17%-17%-21%43%38%27%10%0%0%-11%-12%-14%-16%-31%-41%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 3 9Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.6G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.6h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson310365349 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita53511262Users per 1,000310365349Days per user1552165Cost per day16128310282t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 4 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 3.6C» Variation in days of treatment per user by local health area, 20063.6  Neurological: Drugs for Parkinson’s diseaseRegional variations in days of treatmentAfter we accounted for differences in population age, sex, and health status, there was moderate variation in the average number of days of treatment received per user of Parkinson’s drugs across BC’s LHAs in 2006.In 65 LHAs, the average number of days of treatment received per user of Parkinson’s drugs was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Parkinson’s users in the major population centres of Vancouver South, Vancouver Midtown, and Vancou-ver North East received fewer days of treatment than predicted based on provincial averages.SaanichGreater VictoriaSookeGulf IslandsCowichanLake CowichanAlberniCourtenayCampbell RiverIsland NorthNanaimoQualicumLadysmithNelsonPentictonMerrittPrincetonArmstrongSouth OkanaganCariboo–ChilcotinSummerlandCrestonKamloops100 Mile HouseTrailKimberleyWindermereKootenay LakeCastlegarGrand ForksKeremeosRevelstokeSalmon ArmVernonNorth ThompsonLillooetSouth CaribooEnderbyKettle ValleyCentral OkanaganCranbrookArrow LakesGoldenPeace River NorthKitimatQuesnelPrince RupertSmithersBurns LakePeace River SouthFort NelsonNechakoPrince GeorgeTerrace13%8%0%0%0%0%0%0%0%0%0%0%-22%18%11%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-8%-40%-50%-53%0%0%0%0%0%0%0%0%0%0%0%Maple RidgeAbbotsfordSouth Surrey–White RockHopeChilliwackLangleyMissionAgassiz–HarrisonSurreyDeltaCoquitlamBurnabyNew WestminsterNorth VancouverPowell RiverSunshine CoastVan. Downtown EastsideVancouver City CentreRichmondVancouver WestsideWest Van.–Bowen IslandHowe SoundVancouver SouthVancouver MidtownVancouver North East14%0%0%0%0%0%0%0%0%0%0%0%0%12%0%0%0%0%0%0%0%0%-17%-27%-30%36634932332931231530734834123233835529837134319537932329731435133332035632525340233432431227024533030926321128431134829 420818 7219266312314272354245280225282301341322320318326311317346335337275339342371310308254365336308287310346321291311286356374286316314328320298328373338340245320309310372319290337320339285284266336335305360310360320303301328244300311318342352384319323253346317364376352230175162314325337336309292298275300318306331316341322323284334316348351350274228219U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 4 1Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.6G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.6i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson1-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%552165Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita53511262Users per 1,000310365349Days per user1552165Cost per day16128310282t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 4 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.6d» Variation in cost of treatment per day by local health area, 20063.6  Neurological: Drugs for Parkinson’s diseaseRegional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, average costs per day of Parkinson’s therapy varied considerably across BC’s LHAs in 2006.Average cost per day of Parkinson’s treatment in most Vancouver Coastal LHAs was above levels predicted based on provincial averages for populations of the same age, sex, and health status.Costs per day of Parkinson’s treatment in Northern and Vancouver Island LHAs were generally below levels predicted based on provincial averages.Supplemental data (available online) show that regional variations in dispensing fees paid per day of treatment were only a fraction of regional variations in the costs of the Parkinson’s treatments themselves.AlberniQualicumLake CowichanSaanichGulf IslandsGreater VictoriaCourtenayNanaimoCowichanCampbell RiverSookeIsland NorthLadysmithKettle ValleyEnderbyCastlegarPrincetonSummerlandSouth CaribooSouth Okanagan100 Mile HousePentictonVernonRevelstokeGrand ForksCentral OkanaganCrestonKamloopsKimberleyArmstrongTrailSalmon ArmKootenay LakeCariboo–ChilcotinWindermereMerrittNelsonArrow LakesCranbrookKeremeosGoldenNorth ThompsonLillooetPrince RupertKitimatSmithersPeace River NorthBurns LakePrince GeorgePeace River SouthQuesnelTerraceNechakoFort Nelson$3.17$2.9 9$2.82$2.85$2.68$2.56$2.63$2.61$2.50$2.66$2.50$2.37$2.7 7$3.63$4.09$3.27$3.56$3.02$3.23$3.05$3.09$3.23$3.07$3.23$2.58$2.9 4$2.8 8$2.9 9$2.4 9$2.82$2.61$2.67$2.62$2.46$2.90$2.05$2.10$2.21$2.18$2.11$2.11$1.54$1.33$2.83$2.67$2.80$2.67$2.38$2.4 9$2.10$2.03$2.07$1.92$1.23$3.00$2.8 4$2.7 4$2.8 8$2.8 4$2.7 4$2.8 8$2.92$2.81$3.02$2.90$2.83$3.32$2.36$2.83$2.70$3.03$2.66$2.85$2.73$2.76$2.90$2.83$3.03$2.4 7$2.8 4$2.7 9$2.95$2.51$2.95$2.7 9$2.8 8$2.86$2.72$3.22$2.43$2.57$2.7 9$2.7 8$2.73$3.22$2.63$2.31$2.65$2.63$2.8 7$2.86$2.65$2.91$2.58$2.83$2.9 4$3.09$2.315%5%3%-1%-6%-7%-9%-11%-12%-13%-15%-18%-18%43%37%19%16%13%13%11%11%11%8%6%4%3%3%1%-1%-4%-7%-8%-9%-10%-10%-17%-20%-23%-24%-26%-43%-53%-55%7%1%-3%-7%-11%-16%-21%-34%-35%-48%-63%CoquitlamMissionDeltaMaple RidgeBurnabySouth Surrey–White RockAbbotsfordSurreyLangleyChilliwackNew WestminsterAgassiz–HarrisonHopeVan. Downtown EastsideVancouver WestsideVancouver SouthVancouver MidtownSunshine CoastRichmondNorth VancouverWest Van.–Bowen IslandVancouver North EastPowell RiverVancouver City CentreHowe Sound$3.23$3.01$3.04$3.04$3.24$2.96$2.9 8$2.7 8$2.64$2.55$2.45$1.68$1.9 7$3.68$3.36$3.31$3.17$3.08$3.07$3.07$3.14$3.02$2.80$2.8 8$3.33$2.9 4$2.85$2.92$2.93$3.12$2.8 9$2.92$2.92$2.7 8$2.7 9$2.80$2.32$2.76$3.08$3.01$3.03$2.9 8$2.9 4$2.96$2.9 7$3.05$2.96$2.81$2.8 9$3.359%5%4%4%4%2%2%-5%-5%-9%-13%-33%-34%18%11%9%6%5%3%3%3%2%0%0%-1%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 4 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.6G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.6J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%16128310282Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita53511262Users per 1,000310365349Days per user1552165Cost per day16128310282t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 4 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 3.6e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20063.6  Neurological: Drugs for Parkinson’s diseaseSources of spending deviationAfter we accounted for differences in population age, sex, and health status, variations across BC’s LHAs in spending per capita on Parkinson’s drugs in 2006 resulted from the combined and sometimes coun-teracting effects of variations in rates of use, days of therapy, and costs per day.Some LHAs where use differed significantly from rates predicted based on provincial averages for populations of the same age, sex, and health status did not have statistically significant differences in spending. This is partly the result of offsetting impacts from days per user and costs per day; it is also partly because our methods for estimating spending per capita involve an adjustment for selection bias that reduces confidence intervals for estimates from that model.Greater VictoriaSaanichCourtenaySookeGulf IslandsCowichanLake CowichanAlberniCampbell RiverIsland NorthNanaimoQualicumLadysmithMerritt100 Mile HouseTrailNelsonPentictonPrincetonArmstrongSouth OkanaganCariboo–ChilcotinSummerlandCrestonKamloopsKimberleyWindermereKootenay LakeCastlegarGrand ForksKeremeosRevelstokeSalmon ArmVernonNorth ThompsonLillooetSouth CaribooEnderbyCentral OkanaganArrow LakesCranbrookGoldenKettle ValleyPeace River NorthKitimatPrince RupertSmithersBurns LakePeace River SouthFort NelsonTerraceQuesnelNechakoPrince GeorgeAbbotsfordSouth Surrey–White RockHopeChilliwackLangleyMissionAgassiz–HarrisonSurreyDeltaCoquitlamBurnabyNew WestminsterMaple RidgeVancouver MidtownVancouver North EastPowell RiverSunshine CoastVancouver City CentreRichmondWest Van.–Bowen IslandHowe SoundVancouver SouthVancouver WestsideNorth VancouverVan. Downtown Eastside7%4%0%0%0%0%0%0%0%0%0%0%-3%23%16%0%0%0%0%0%0%-2%-6%-8%-15%0%0%0%0%0%0%0%0%0%0%0%0%14%-27%-30%0%0%0%0%0%0%-17%0%12%0%2%2%-34%-9%-5%5%-33%-5%4%9%4%-13%4%6%2%0%5%0%3%3%-1%9%11%3%18%0%0%0%0%0%0%0%-11%-12%-17%-17%-21%0%43%38%27%0%-11%-12%-31%-41%10%-14%-16%0%11%8%0%0%0%0%0%0%0%0%0%-14%-20%66%20%16%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-5%-37%-64%25%1%0%0%0%0%0%0%0%-5%-9%8%13%0%0%0%0%0%0%0%0%0%0%-22%0%0%0%18%11%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-8%-50%-40%-53%0%0%0%0%0%0%0%0%0%0%0%0%8%0%0%0%0%0%0%0%0%0%-11%-19%0%81%0%0%19%27%37%30%28%26%23%22%13%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%28%0%0%0%0%0%0%-44%0%0%0%-7%-1%-9%-15%-6%-12%-3%5%-13%-18%-11%5%-18%-17%11%-7%-20%11%16%-4%11%-10%13%3%1%-1%-10%-9%19%4%-26%6%-8%8%-53%-55%13%37%3%-23%-24%-43%43%-7%1%7%-3%-11%-21%-63%-35%-34%-48%-16%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 4 5Neurological drugsPsychostimulants3.7t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 4 6Introductionfigure 3.7d» Spending per capita in BC, by age group and source of finance, 2006figure 3.7C» Percentage of drug types within category covered by BC PharmaCare, 2006figure 3.7B» Percentage of spending within category by specific drug types, 2006figure 3.7a» Spending within category relative to spending on all prescription drugs, 2006Modafinil 5%Amfetamine 8%Atomoxetine 17%Dexamfetamine 25%Methylphenidate 45%Total drug spendingper capitaSpending per capita on psychostimulants$3 $410ModafinilAmfetamineAtomoxetineDexamfetamineMethylphenidate5%8%17%25%45%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered20%40%40%Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita0-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population2015105$20$15$10$5$0.30Private spendingPublic spending92354 4 421 161%39%72%28%70%30%69%31%69%31%82%18%80%20%$1.72 $1.57 $1.73 $1.62$0.97$0.4330%70%67%33%67%33%89%11%12%67%33%88%$11.85$4.1751% private;49% public45% private;55% public34% private;66% public52% private;48% publicUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publicly55% private;45% publicModafinil 5%Amfetamine 8%Atomoxetine 17%Dexamfetamine 25%Methylphenidate 45%Total drug spendingper capitaSpending per capita on psychostimulants$3 $410ModafinilAmfetamineAtomoxetineDexamfetamineMethylphenidate5%8%17%25%45%Unrestricted coverageListing status as of December 2006Restricted coverageNot covered20%40%40%3.7  Neurological: PsychostimulantsTotal spending in BC: $12-millionSpending per capita in BC: $2.96Dispensing fees as percent of spending: 12%Users of treatment per 1,000 pop. in BC: 6Spending per user of treatment in BC: $468.29Days of treatment per user in BC: 224Cost of treatment per day in BC: $2.10Common goal of therapyReduce symptons of attention deficit •	hyperactivity disorder (ADHD)Examples of indicated conditionsAttention deficit hyperactivity disorder •	(ADHD)U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 4 7figure 3.7e» Users of treatment per 1,000 residents in BC, by age group and primary source of finance, 2006Overall spending and useBritish Columbians spent $12 million, or $2.96 per capita, on psychostimulant drugs in 2006. In terms of spending per capita, this was the smallest therapeutic category studied. However, it was the most highly concentrated among children.Users of psychostimulant prescriptions received an average of 224 days of treatment, indicating that many take these medicines relatively persistently. The average total spending on psychostimulants per user was $468.29.Leading drugs in classMethylphenidate drugs accounted for 45% of psychostimulant spending (dominated by the brands Concerta and Ritalin-SR); dexamfetamine products accounted for 25% of spending; atomoxetine (brand name Strattera) accounted for 17%; and amphet-amine combinations (brand name Adderall XR) accounted for 8%.Provincial formulary coverageBC PharmaCare provided coverage for three of five types of psychostimulant drug sold in Canada in 2006.Spending and use by ageThe use of and spending on psychostimulant drugs in BC was highly concentrated among children and young adults. Almost two-thirds (63%) of spending in this category was on prescriptions purchased for residents under 20 years of age.Approximately one in 50 persons aged 10–19 filled at least one psychostimulant prescription in 2006. The average total spending on psychostimulants was $4.17 per capita among children under age 10 and $11.85 per capita among those aged 10–19.Nearly 90% of the spending on psychostimulants for residents under age 20 was privately financed (through private insurance or out of pocket).Numberof peopleAge group0-9Numberof peopleAge group361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Spending per capita0-9361,726 489,846 501,728 530,510 657,126 594,597 376,293 251,621 172,96310-19 20-29 30-39 40-49 50-59 60-69 70-79 80+Users of treatment per 1,000 population2015105$20$15$10$5$0.30Private spendingPublic spending92354 4 421 161%39%72%28%70%30%69%31%69%31%82%18%80%20%$1.72 $1.57 $1.73 $1.62$0.97$0.4330%70%67%33%67%33%89%11%12%67%33%88%$11.85$4.1751% private;49% public45% private;55% public34% private;66% public52% private;48% publicUsers for whom >50% of costs were paid privatelyUsers for whom ≥50% of costs were paid publicly55% private;45% publict h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 4 8Spending per capitaVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActual value for LHAPredicted value for LHALog.devi-ationLocal health areaActual value for LHAPredicted value for LHALog.devi-ationNote: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).table 3.7a» Variation in spending per capita by local health area, 20063.7  Neurological: PsychostimulantsRegional variations in spending per capitaAfter we accounted for differences in population age, sex, and health status, spending on psychostimulants varied moderately across BC’s LHAs in 2006.In 65 LHAs, psychostimulant spending per capita was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.Spending per capita on psychostimulants in Vancouver South and Burnaby was well below levels predicted based on provincial averages. Spending per capita on psychostimulants in North Vancouver, Keremeos, Central Okanagan, and Kamloops was well above levels predicted based on provincial averages.AlberniGreater VictoriaSookeSaanichGulf IslandsCowichanLake CowichanLadysmithNanaimoQualicumCourtenayCampbell RiverIsland NorthKeremeosCentral OkanaganKamloopsSummerlandCariboo–ChilcotinCranbrookKimberleyWindermereCrestonKootenay LakeCastlegarArrow LakesTrailGrand ForksKettle ValleySouth OkanaganPentictonPrincetonGoldenRevelstokeSalmon ArmArmstrongVernon100 Mile HouseNorth ThompsonLillooetSouth CaribooMerrittEnderbyNelsonQuesnelPrince RupertSmithersBurns LakeNechakoPrince GeorgeKitimatTerracePeace River SouthPeace River NorthFort Nelson$2.8$3.3$3.3$2.8$2.3$2.8$2.5$2.0$2.8$1.6$3.7$3.5$2.9$2.2$4. 8$ 4.1$6.2$2.3$3.0$2.8$3.2$1.5$1.1$1.9$1.7$3.1$1.8$0.8$ 4.1$5.0$5.2$3.5$4.6$3.9$3.2$4.0$1.5$2.0$2.7$2.2$3.3$1.7$1.1$3.4$3.4$2.4$2.1$2.0$4.6$1.9$3.7$1.8$1.4$2.0$2.8$3.1$3.4$2.8$2.4$2.9$2.9$2.0$2.8$1.8$3.6$3.0$2.8$1.6$4.0$3.4$5.6$2.2$2.8$1.5$2.3$1.8$1.8$1.7$2.4$3.0$2.0$1.3$3.5$4.2$ 4.6$2.8$2.9$3.4$2.9$3.0$1.8$2.0$2.9$1.7$3.7$1.8$1.6$3.2$2.3$2.3$2.1$2.5$4.2$1.8$2.8$2.0$1.7$2.61%0%0%0%0%0%0%0%0%0%0%0%0%31%19%19%9%2%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-32%7%0%0%0%0%0%0%0%-10%-22%-27%South Surrey–White RockLangleyChilliwackHopeAbbotsfordDeltaNew WestminsterMissionAgassiz–HarrisonSurreyMaple RidgeCoquitlamBurnabyNorth VancouverHowe SoundRichmondWest Van.–Bowen IslandSunshine CoastPowell RiverVancouver City CentreVan. Downtown EastsideVancouver North EastVancouver WestsideVancouver MidtownVancouver South$3.1$4.2$3.2$3.4$2.5$4.2$2.1$3.2$3.4$2.6$3.9$2.9$1.5$3.8$2.7$2.2$3.8$2.2$3.4$2.6$2.5$1.7$3.2$1.8$1.5$2.9$ 4.0$3.2$3.5$2.9$3.6$2.6$3.4$2.9$3.4$ 4.0$3.2$2.2$3.0$2.7$2.5$3.1$2.4$2.4$1.7$2.2$2.6$2.3$2.2$2.47%5%1%0%0%0%0%0%0%0%-5%-10%-39%22%2%0%0%0%0%0%0%0%0%0%-46%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 4 9Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.7G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.7f» Regional variation in spending per capita» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson33214-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%165Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita33214165Users per 1,000510755344Days per user1251691Cost per day11049856t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 5 0Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Users of treatment per 1,000 residentsVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvaluefor LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.7B» Variation in users of treatment per 1,000 residents by local health area, 20063.7  Neurological: PsychostimulantsRegional variations in rate of useAfter we accounted for differences in population age, sex, and health status, the number of psychostimulant users per 1,000 residents varied significantly across BC’s LHAs in 2006. These variations were greatest among Vancouver Coastal LHAs.The use of psychostimulants in several Vancouver Coastal, Interior, and Northern LHAs was well above rates predicted based on provincial averages for populations of the same age, sex, and health status. Psychostimulant use in several Fraser LHAs was well below rates predicted based on provincial averages.Campbell RiverGreater VictoriaAlberniSookeSaanichGulf IslandsCowichanLake CowichanLadysmithNanaimoQualicumCourtenayIsland NorthKimberleyRevelstokeKeremeosVernonWindermerePentictonCentral OkanaganKamloopsSalmon ArmSouth OkanaganSummerlandCariboo–ChilcotinCranbrookCrestonKootenay LakeCastlegarArrow LakesTrailGrand ForksKettle ValleyPrincetonGoldenArmstrong100 Mile HouseNorth ThompsonLillooetSouth CaribooMerrittEnderbyNelsonPrince RupertTerracePrince GeorgeQuesnelSmithersBurns LakeKitimatPeace River SouthFort NelsonPeace River NorthNechako77876465464857128961198889673264643977457686389109655564466776466465854757598777967435665485655759655798655585514%8%0%0%0%0%0%0%0%0%0%0%0%61%50%38%30%29%19%17%16%15%14%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-28%39%29%8%0%0%0%0%0%0%-18%-28%DeltaSouth Surrey–White RockLangleyChilliwackHopeMissionAgassiz–HarrisonMaple RidgeCoquitlamAbbotsfordNew WestminsterSurreyBurnabyVancouver City CentrePowell RiverVancouver WestsideNorth VancouverWest Van.–Bowen IslandVan. Downtown EastsideHowe SoundSunshine CoastRichmondVancouver MidtownVancouver SouthVancouver North East9688976766454687785755443868797686667546566565655513%0%0%0%0%0%0%-8%-12%-16%-23%-25%-37%40%36%34%20%20%14%0%0%-14%-22%-42%-44%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 5 1Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.7G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.7h» Regional variation in users of treatment per 1,000 residents» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson510755344 -5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita33214165Users per 1,000510755344Days per user1251691Cost per day11049856t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 5 2Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Vancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationDays of treatment per usertable 3.7C» Variation in days of treatment per user by local health area, 20063.7  Neurological: PsychostimulantsRegional variations in days of treatmentIn contrast to the significant regional variations in the number of psychostimulant users across BC’s LHAs in 2006, there was only modest variation in the average number of days of treatment received per user after we accounted for differences in population age, sex, and health status.In 69 LHAs, the number of days of treatment received per user of psychostimulants was either within 5% of, or not statistically significantly different from, levels predicted based on provincial averages for populations of the same age, sex, and health status.The numbers of days of psychostimulant treatment received per user in a few Vancouver Coastal and Fraser LHAs were below levels predicted based on provincial averages.Gulf IslandsAlberniGreater VictoriaCampbell RiverSookeSaanichCowichanLake CowichanLadysmithNanaimoQualicumCourtenayIsland NorthTrailKamloopsKimberleyRevelstokeKeremeosVernonWindermerePentictonCentral OkanaganSalmon ArmSouth OkanaganSummerlandCariboo–ChilcotinCranbrookCrestonKootenay LakeCastlegarArrow LakesGrand ForksKettle ValleyPrincetonGoldenArmstrong100 Mile HouseNorth ThompsonLillooetSouth CaribooMerrittEnderbyNelsonPrince GeorgePrince RupertTerraceQuesnelSmithersBurns LakeKitimatPeace River SouthFort NelsonPeace River NorthNechako27%13%4%0%0%0%0%0%0%0%0%0%0%19%8%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%5%0%0%0%0%0%0%0%0%0%0%South Surrey–White RockLangleyChilliwackHopeMissionAgassiz–HarrisonMaple RidgeCoquitlamAbbotsfordSurreyBurnabyNew WestminsterDeltaVancouver City CentrePowell RiverVancouver WestsideNorth VancouverWest Van.–Bowen IslandVan. Downtown EastsideSunshine CoastVancouver MidtownVancouver North EastRichmondVancouver SouthHowe Sound0%0%0%0%0%0%0%0%0%0%-7%-10%-11%0%0%0%0%0%0%0%0%0%-6%-11%-17%29125423522220822123427121323722223524126924218419 720022922522623220925025520821424 926523622119918125622123621421720021619918619824 420924322320523922720818 7208265223223226223225224225222220226223229216224223218218224220220228227228228231219228224216225233224216231222222221224231217227223222232216222231220216213222236217231229233233202237240231226226223208204201222244209221218212238212237213201186222227226230224227225225225227223227225218221216220218220224224225225225221U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 5 3Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.7G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.7i» Regional variation in days of treatment per user» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson125-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%1691Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita33214165Users per 1,000510755344Days per user1251691Cost per day11049856t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 5 4Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Cost of treatment per dayVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationLocal health areaActualvalue for LHAPredictedvalue for LHALog.devi-ationtable 3.7d» Variation in cost of treatment per day by local health area, 20063.7  Neurological: PsychostimulantsRegional variations in cost per dayAfter we accounted for differences in population age, sex, and health status, the average cost per day of psychostimulant treatment received in BC’s LHAs varied moderately in 2006.The average costs per day of psychostimulant treat-ment in several Vancouver Coastal and Fraser LHAs were higher than levels predicted based on provincial averages for populations of the same age, sex, and health status.Supplemental data (available online) show that varia-tions in dispensing fees paid per day of psychostimu-lant treatment were less than variations in the costs of drugs themselves.Greater VictoriaSookeSaanichGulf IslandsCowichanLake CowichanLadysmithCourtenayCampbell RiverIsland NorthNanaimoQualicumAlberniSummerlandSalmon ArmCentral OkanaganCranbrookKimberleyWindermereCrestonKootenay LakeArrow LakesGrand ForksKettle ValleySouth OkanaganPentictonPrincetonGoldenRevelstokeArmstrongNorth ThompsonLillooetSouth CaribooMerrittKamloopsVernonTrailCariboo–ChilcotinNelsonEnderby100 Mile HouseCastlegarKeremeosPrince RupertSmithersBurns LakeNechakoPeace River SouthKitimatFort NelsonPrince GeorgeTerraceQuesnelPeace River North$2.03$2.22$2.21$2.19$2.20$2.05$2.16$2.03$2.14$2.29$1.9 4$1.76$1.4 7$2.71$2.32$2.20$2.00$2.36$2.29$1.81$2.37$1.86$2.04$1.63$2.00$2.02$2.18$2.42$1.90$1.9 8$1.8 8$2.05$1.64$2.06$2.02$1.91$1.86$1.75$1.67$1.59$1.54$1.43$1.4 4$2.08$1.91$1.95$1.83$1.82$1.68$1.7 4$1.95$1.68$1.73$1.56$2.07$2.11$2.12$2.01$2.05$2.16$1.9 7$2.13$2.11$2.15$2.09$2.04$2.09$2.12$2.14$2.13$2.10$2.03$2.07$2.06$2.09$2.05$2.03$2.18$2.17$2.12$2.18$2.09$2.08$2.03$2.15$2.18$2.11$2.14$2.11$2.07$2.11$2.06$2.03$2.08$2.09$2.02$2.09$2.01$2.06$2.10$2.15$2.04$2.03$2.22$2.17$2.10$2.16$2.030%0%0%0%0%0%0%0%0%0%-8%-15%-35%25%8%3%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-4%-8%-12%-17%-20%-27%-31%-35%-38%0%0%0%0%0%0%0%-11%-22%-22%-26%DeltaNew WestminsterMaple RidgeSouth Surrey–White RockCoquitlamLangleyHopeBurnabyAgassiz–HarrisonSurreyAbbotsfordMissionChilliwackWest Van.–Bowen IslandNorth VancouverVan. Downtown EastsideVancouver WestsideRichmondSunshine CoastHowe SoundVancouver City CentreVancouver North EastVancouver MidtownVancouver SouthPowell River$2.36$2.33$2.37$2.26$2.30$2.32$1.85$1.9 7$2.25$2.19$1.9 9$1.95$1.80$2.29$2.32$2.22$2.08$2.02$1.93$2.22$1.92$2.10$1.9 7$2.13$1.76$2.11$2.09$2.12$2.03$2.09$2.12$2.12$2.06$2.08$2.13$2.12$2.12$2.10$2.03$2.06$1.9 7$1.9 8$2.09$2.00$2.07$1.9 4$2.05$2.04$2.04$2.0611%11%11%11%9%9%0%0%0%0%-6%-8%-15%12%12%12%5%0%0%0%0%0%0%0%-16%U B C  C e n t r e  f o r  h e a lt h  s e r v i C e s  a n d  p o l i C y  r e s e a r C h1 5 5Relatively high given the age, sex, and health status of LHA residentsRelatively low given the age, sex, and health status of LHA residentsLHAs have been resized torepresent their population.1,000 peopleData are unreliablefigure 3.7G» Extent of regional variation» Number of local health areas with given deviations of actual values from predictions based on provincial averages for populations of the same age, sex, and health status, 2006figure 3.7J» Regional variation in cost of treatment per day» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 2006Snow CountryStikineTelegraph CreekUpper SkeenaNechakoPrince GeorgeQuesnelCariboo–Chilcotin100 MileHouse   SalmonArmRevelstokeEnderbyVernonGoldenCastlegarTrailGrand ForksKettle ValleySouth OkanaganKeremeosChilliwackHopeAgassiz–HarrisonMissionMapleRidgeRichmondVancouver SouthVancouverNortheastVancouverDowntown EastsideNorthVancouverHoweSoundPowellRiverIslandNorthCampbellRiverCourtenayQualicumAlberniNanaimoGulfIslandsSaanichGreaterVictoriaCowichanSookeLadysmithLakeCowichanIslandWestSunshineCoast West   Van.–Bowen I.VancouverCityCentreVancouverMidtownVancouverWestsideDeltaSurreyBurnabySouth Surrey–White RockCoquitlamNewWestminsterAbbotsfordLangleyPentictonPrincetonCrestonCranbrookFernieWindermereArrowLakesKootenayLakeCentralOkanaganArmstrongLillooetSouthCariboo MerrittSummerlandKamloopsNorthThompsonFort NelsonPeace RiverNorthPeace RiverSouthBurns LakeBella CoolaCentral CoastSmithersTerraceKitimatQueenCharlottePrinceRupertNisga’aKimberleyNelson11049856-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Logarithmic scaleIndicates one LHALogarithmic scaleIndicates one LHA-5 to +5%+6 to +15%+16 to +25%> +25%-15 to -6%< -25%-25 to -16%Spending per capita33214165Users per 1,000510755344Days per user1251691Cost per day11049856t h e  B C  r x  a t l a s ,  2 n d  e d i t i o n1 5 6Note: Log deviation reported as zero when not statistically significant (see “Testing significance” on page 9).Summary of measures of deviationVancouver Island HealthInterior HealthNorthern HealthFraser HealthVancouver Coastal HealthSpendingpercapitaDaysperuserUsersper1,000CostperdayLocal health areaLocal health areaSpendingpercapitaDaysperuserCostperdayUsersper1,000table 3.7e» Regional variation» Deviation of actual values for local health areas from predictions based on provincial averages for populations of the same age, sex, and health status, 20063.7  Neurological: PsychostimulantsSources of spending deviationAfter we accounted for differences in population age, sex, and health status, regional variations in psycho-stimulant spending per capita in BC in 2006 resulted almost entirely from variations in the number of users per 1,000 residents among LHAs.Some LHAs where use differed significantly from rates predicted based on provincial averages for populations of the same age, sex, and health status did not have statistically significant differences in spending. This is partly the result of offsetting impacts from days per user and costs per day; it is also partly because our methods for estimating spending per capita involve an adjustment for selection bias that reduces confidence intervals for estimates from that model.AlberniIsland NorthCampbell RiverCowichanSookeGulf IslandsGreater VictoriaSaanichLake CowichanLadysmithNanaimoCourtenayQualicumKeremeosCentral OkanaganKamloopsSummerlandCariboo–ChilcotinWindermereTrailKimberleyPentictonSalmon ArmSouth OkanaganCranbrookCrestonKootenay LakeArrow LakesGrand ForksPrincetonGoldenArmstrongNorth ThompsonLillooetSouth CaribooMerrittEnderbyVernonRevelstokeCastlegar100 Mile HouseKettle ValleyNelsonQuesnelPrince RupertSmithersBurns LakeKitimatPrince GeorgeNechakoTerracePeace River SouthPeace River NorthFort NelsonSouth Surrey–White RockLangleyChilliwackAgassiz–HarrisonNew WestminsterDeltaSurreyMissionAbbotsfordHopeMaple RidgeCoquitlamBurnabyNorth VancouverHowe SoundVan. Downtown EastsideWest Van.–Bowen IslandVancouver City CentrePowell RiverVancouver WestsideSunshine CoastVancouver MidtownVancouver North EastRichmondVancouver South7%5%1%0%0%0%0%0%0%0%-5%-10%-39%22%2%0%0%0%0%0%0%0%0%0%-46%0%0%0%0%-10%-11%0%0%0%0%0%0%-7%0%-17%0%0%0%0%0%0%0%0%-6%-11%11%9%-15%0%11%11%0%-8%-6%0%11%9%0%12%0%12%12%0%-16%5%0%0%0%0%0%0%0%0%0%-23%13%-25%0%-16%0%-8%-12%-37%20%0%14%20%40%36%34%0%-22%-44%-14%-42%1%0%0%0%0%0%0%0%0%0%0%0%0%31%19%19%9%2%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%-32%7%0%0%0%0%0%0%0%-10%-22%-27%13%0%0%0%0%27%4%0%0%0%0%0%0%0%0%8%0%0%0%19%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%5%0%0%0%0%0%0%0%14%0%0%