Effect of the Choosing Wisely Canada campaign on prescription of nonsteroidal anti-inflammatory drugs in people with hypertension, heart failure and chronic kidney disease in Canada

The Choosing Wisely Canada (CWC) campaign focuses on helping physicians and patients engage in conversations about unnecessary tests and treatments. In 2014, a CWC recommendation advised against prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) in individuals with hypertension, heart failure or chronic kidney disease (CKD). We evaluated the impact of this recommendation on prescription of NSAIDs in British Columbia (BC), Canada. We identified all persons continuously registered with BCs Medical Service Plan at any point between October 1, 2011 and December 31, 2017 with hypertension, heart failure or CKD. Using prescription claims data and an interrupted time series analysis, we estimated the quarterly number of people initiating NSAIDs and the proportion of days covered (PDC). We also conducted sub-group analyses to study the impact of the recommendation by patients demographics (sex and age). We analyzed 1,479,704 NSAID claims from 903,732 patients with a diagnosis of hypertension, heart failure and/or CKD. Overall, we found no statistically significant change either immediately or over time in initiation and PDC of NSAIDs. However, we did observe a decrease in both initiation and PDC of NSAIDs over time among male patients and patients aged [≤]65 years. We found that the CWC recommendation had a mixed impact, with initiation and PDC of NSAIDs significantly declining only among male and younger patients. HighlightsO_LIReducing low-value care can help to counter increasing healthcare spending. C_LIO_LICWC can contribute to reducing low-value care, however, evidence on its effectiveness remains elusive. C_LIO_LICWC led to NSAIDs prescription decline for patients [≤]65 years and male patients. C_LIO_LIOverall, NSAID prescribing has been declining over time irrespective of CWC. C_LI