Time trends in medication use and expenditures in older patients with rheumatoid arthritis.
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).


CONCLUSIONS
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.
Meyers Primary Care Institute, Worcester, MA, USA. Leslie.Harrold@umassmed.edu
Leslie R
LR
Harrold
Daniel
D
Peterson
Ashley J
AJ
Beard
Jerry H
JH
Gurwitz
Becky A
BA
Briesacher
D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics*; D016527:Drug Costs; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D000068800:Etanercept; D005260:Female; D005102:Health Expenditures / Q000639:trends*; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D016345:Medicare Part B; D054524:Medicare Part D; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012494:Sampling Studies; D013997:Time Factors; D014481:United States
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept