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Impact of consumer copayments for subsidised medicines on health services use and outcomes: a protocol using linked administrative data from Western Australia
  1. Karla L Seaman1,
  2. Frank M Sanfilippo2,
  3. Elizabeth E Roughead3,
  4. Max K Bulsara1,
  5. Anna Kemp-Casey3,4,
  6. Caroline Bulsara1,
  7. Gerald F Watts5,
  8. David Preen4
  1. 1 School of Health Sciences, The University of Notre Dame, Fremantle, Western Australia, Australia
  2. 2 Cardiovasular Research, School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
  3. 3 Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, The University of South Australia, Adelaide, South Australia, Australia
  4. 4 Center of Health Services Research, School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
  5. 5 Department of Cardiology, Lipid Disorders Clinic, Royal Perth Hospital, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
  1. Correspondence to Karla L Seaman; karla.seaman1{at}


Introduction Across the world, health systems are adopting approaches to manage rising healthcare costs. One common strategy is a medication copayments scheme where consumers make a contribution (copayment) towards the cost of their dispensed medicines, with remaining costs subsidised by the health insurance service, which in Australia is the Federal Government.

In Australia, copayments have tended to increase in proportion to inflation, but in January 2005, the copayment increased substantially more than inflation. Results from aggregated dispensing data showed that this increase led to a significant decrease in the use of several medicines. The aim of this study is to determine the demographic and clinical characteristics of individuals ceasing or reducing statin medication use following the January 2005 Pharmaceutical Benefit Scheme (PBS) copayment increase and the effects on their health outcomes.

Methods and analysis This whole-of-population study comprises a series of retrospective, observational investigations using linked administrative health data on a cohort of West Australians (WA) who had at least one statin dispensed between 1 May 2002 and 30 June 2010. Individual-level data on the use of pharmaceuticals, general practitioner (GP) visits, hospitalisations and death are used.

This study will identify patients who were stable users of statin medication in 2004 with follow-up commencing from 2005 onwards. Subgroups determined by change in adherence levels of statin medication from 2004 to 2005 will be classified as continuation, reduction or cessation of statin therapy and explored for differences in health outcomes and health service utilisation after the 2005 copayment change.

Ethics and dissemination Ethics approvals have been obtained from the Western Australian Department of Health (#2007/33), University of Western Australia (RA/4/1/1775) and University of Notre Dame (0 14 167F). Outputs from the findings will be published in peer reviewed journals designed for a policy audience and presented at state, national and international conferences.

  • Co-payments
  • Pharmaceutical Benefit Scheme
  • Data-linkage
  • Statins
  • Health Outcomes

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  • Contributors KLS is a PhD scholar on the study supervised by MKB, CB, DP and FMS. She wrote the first draft of the manuscript, coordinated the responses and comments from the coauthors and finalised the manuscript for submission. DP and ER designed the study, are investigators on the grant and reviewed the manuscript to provide critical comment. AK-C, MKB, CB, GFW and FMS reviewed the manuscript and provided critical comment.

  • Competing interests None declared.

  • Ethics approval The Western Australian Department of Health (#2007/33), The University of Western Australia (RA/4/1/1775) and The University of Notre Dame (014167F).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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