Colchicine price hike led to decreased use for gout, more prescription swaps, ED visits
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Key takeaways:
- The 2010 increase in colchicine prices was immediately followed by a decrease in the drug’s use for gout.
- Rheumatology and ED visits related to gout rose following the price changes.
Following a major price increase in 2010, the use of colchicine for gout declined while rheumatology and emergency department visits for the disease increased, according to data published in JAMA Internal Medicine.
“We came across this study in 2020 or 2021 that discussed colchicine's large price increase,” Dan P. Ly, MD, PhD, MPP, an assistant professor at the David Geffen School of Medicine at the University of California, Los Angeles, told Healio. “We wondered how patients and their doctors responded to this large price increase, such as stopping colchicine or switching to a different medication, and what the consequences of this price increase were.”
To investigate the impact the 2010 price increase had on colchicine prescriptions and use, Ly and colleagues conducted a retrospective cohort study. The researchers collected and evaluated data from 2007 to 2019 in the MarketScan database, which includes information for prescription drug prices and usage. For the purposes of the analysis, the Ly and colleagues included data from all patients diagnosed with gout and who had medical and prescription data corresponding to the years when they were enrolled for 12 continuous months.
The researchers focused on three primary outcomes. The first outcome of interest was the price of colchicine, as defined as the price per prescription and the price per pill. The second outcome was the use of colchicine, which was defined as the number of pills supplied to patients each year. Finally, the researchers analyzed the frequency of medical visits that were “plausibly associated” with gout management, they wrote.
The analysis included a total of 2,723,327 patient-year observations from 2007 to 2019. According to the researchers, the mean price per prescription for colchicine increased nearly 16-fold, from $11.25 (95% CI, $11.23-$11.28) in 2009 to $190.49 (95% CI, $190.07-$190.91) in 2011. Meanwhile, the mean out-of-pocket price increased 4.4-fold, from $7.37 (95% CI, $7.37-$7.38) to $39.49 (95% CI, $39.42-$39.56) during the same time period.
The researchers additionally reported that the number of pills used by patients with gout dropped from 35 per patient per year (95% CI, 34.6-35.5) to 22.6 (95% CI, 22.2-23) in 2019. In all, the adjusted analyses demonstrated a 16.7% decrease in colchicine use during year 1 and a 27% reduction through the decade (P<.001).
In addition, the use of allopurinol increased by 33.1 pills per patient (95% CI, 32.6-33.7) through 2019, representing a 32% increase from baseline through the decade, according to the researchers. Meanwhile, adjusted oral corticosteroid use increased by 1.5 (95% CI, 1.3-1.7) pills per patient through 2019, representing an 8.3% increase from baseline during the decade.
Finally, ED visits related to gout increased by 0.05 per patient (95% CI, 0.04-0.05) through 2019, indicating a 39.8% increase over the decade (P < .001).
“We find that this large price increase in colchicine came with a decrease in colchicine use, an increase in allopurinol and steroid use, and an increase in rheumatology and ED visits,” Ly said. “Price increases for medications like colchicine can have consequences for patient health, and rheumatologists and other doctors need to do their best to work with their patients to mitigate such consequences.”
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