title: Impact of managed care on the use of biologic agents for rheumatoid arthritis.
abstract: OBJECTIVE
  To compare the use of biologic agents among persons with rheumatoid arthritis (RA) in managed care and fee-for-service settings.
  
  
  METHODS
  The present study uses data from the University of California, San Francisco RA Panel Study in which 529 patients with RA from a random sample of northern California rheumatologists were interviewed annually between 1999 and 2002 using a structured survey instrument. Linear and logistic regression were used to compare current utilization, initiation, and cessation of biologic agents and other treatments among patients with RA in managed care and fee-for-service settings, with and without adjustment for differences in demographic and health characteristics.
  
  
  RESULTS
  After adjustment, patients with RA in health maintenance organizations (HMOs) were significantly less likely to use biologic agents than those in other managed care settings (difference of -6.6%; 95% confidence interval [95% CI] -11.4%, -1.7%) or than those in fee-for-service settings (difference of -12.5%; 95% CI -19.0%, -5.9%); patients in other managed care settings and fee-for-service did not differ significantly in their use of biologic agents. Patients with RA in HMOs were significantly less likely than those in other managed care settings to initiate the use of biologic agents (difference of -7.3%; 95% CI -11.5%, -3.1%); there were no other differences between patients in HMOs and those in other managed care and fee-for-service settings in rates of initiation or cessation of these agents. Patients with RA in HMOs were less likely to use methotrexate, cyclooxygenase 2 (COX-2) inhibitors, and corticosteroids than those in other managed care settings; they were also less likely to use COX-2 inhibitors than those in fee-for-service settings.
  
  
  CONCLUSIONS
  Patients with RA in HMOs were significantly less likely to use biologic agents than those in other managed care and fee-for-service settings, primarily due to lower rates of initiation.
authors.affiliation: Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco 94143-0920, USA. yelin2@itsa.ucsf.edu
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yelin
authors.forename: Laura S
authors.initials: LS
authors.lastname: Trupin
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D002140:California; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D001688:Biological Products; D016861:Cyclooxygenase Inhibitors; D008727:Methotrexate