Time trends in medication use and expenditures in older patients with rheumatoid arthritis
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine; Department of Medicine, Division of Rheumatology
Medical Subject Headings
Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Rheumatoid; *Drug Costs; Drug Prescriptions; Female; Health Expenditures; Humans; Immunoglobulin G; Male; Medicare Part B; Medicare Part D; Receptors, Tumor Necrosis Factor; Sampling Studies; Time Factors; United States
Geriatrics | Health Services Research | Pharmacy and Pharmaceutical Sciences | Primary Care | Rheumatology
BACKGROUND: We sought to examine how expansions in insurance coverage of nonbiologic and biologic disease-modifying antirheumatic drugs affected the access, costs, and health status of older patients with rheumatoid arthritis.
METHODS: We identified a nationally representative sample of older adults with rheumatoid arthritis in the 2000-2006 Medicare Current Beneficiary Survey (unweighted n=1051). We examined changes in disease-modifying antirheumatic drug use, self-reported health status, functional status (activities of daily living), and total costs and out-of-pocket costs for medical care and prescription drugs. Tests for time trends were conducted using weighted regressions.
RESULTS: Between 2000 and 2006, the proportion of older adults with rheumatoid arthritis who received biologics tripled (4.6% vs 13.2%, P=.01), whereas the proportion of people who used a nonbiologic did not change. During the same period, the proportion of older patients with rheumatoid arthritis rating their health as excellent/good significantly increased (43.0% in 2000 to 55.6% in 2006; P=.015). Significant improvements occurred in activities of daily living measures of functional status. Total prescription drug costs (in 2006 US dollars) increased from $2645 in 2000 to $4685 in 2006, P=.0001, whereas out-of-pocket prescription costs remained constant ($842 in 2000 vs $832 in 2006; P=.68). Total medical costs did not significantly increase ($16,563 in 2000 vs $19,510 in 2006; P=.07).
CONCLUSION: Receipt of biologics in older adults with rheumatoid arthritis increased over a period of time when insurance coverage was expanded without increasing patients' out-of-pocket costs. During this time period, concurrent improvements in self-reported health status and functional status suggest improved arthritis care.
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Citation: Am J Med. 2012 Sep;125(9):937.e9-15. doi: 10.1016/j.amjmed.2011.11.014. Epub 2012 Jun 9. Link to article on publisher's site
Harrold, Leslie R.; Peterson, Daniel J.; Beard, Ashley J.; Gurwitz, Jerry H.; and Briesacher, Becky A., "Time trends in medication use and expenditures in older patients with rheumatoid arthritis" (2012). Meyers Primary Care Institute Publications and Presentations. 596.