Biological and steroid use in relationship to quality measures in older patients with inflammatory bowel disease: a US Medicare cohort study.
OBJECTIVE
To examine the frequency and predictors of antitumour necrosis factor (TNF) use, and to describe steroid utilisation among US patients with inflammatory bowel disease (IBD) aged 65 years and older prior to the publication of a new Medicare quality measure calling for the use of anti-TNFs and other steroid-sparing agents.


METHODS
Retrospective cohort study.


METHODS
This study utilised 2006-2009 claims data for a national sample of Medicare beneficiaries.


METHODS
Patients with IBD (>1 claim for ICD codes 555.xx, 556.xx) without anti-TNF contraindications, enrolled in Medicare parts A and B ≥12 months and part D ≥6 months were included (n=8502).


METHODS
We estimated incidence rate ratios (IRR) and 95% CIs predicting new anti-TNF therapy using multivariable Poisson regression.


RESULTS
This nationally representative study of older patients with IBD estimated that only 3.7% received anti-TNFs. New anti-TNF use (1.4%) was associated with younger age, absence of Medicaid coverage, hospitalisation, and higher preceding use of burst (IRR=2.35, CI 1.59 to 3.47) and maintenance steroids (IRR=2.40, CI 1.05 to 5.48). Among anti-TNF users, we observed high rates of concurrent maintenance steroid use (19%).


CONCLUSIONS
Anti-TNF use was very low in this population of older patients with IBD and, importantly, was often combined with maintenance steroid use despite guidelines suggesting reduced needs. Expanding IBD-specific quality measures to include steroid taper plans may cue appropriate maintenance regimens that include anti-TNFs and other steroid sparing agents while reducing protracted concomitant steroid use as intended by current quality measures.
Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
Sophia L
SL
Johnson
Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Christie M
CM
Bartels
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Mari
M
Palta
Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA.
Carolyn T
CT
Thorpe
Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Jennifer M
JM
Weiss
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Maureen A
MA
Smith
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000191:economics*; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D006278:Medicare / Q000191:economics; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology; D014481:United States
D000911:Antibodies, Monoclonal; D013256:Steroids; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
GERIATRIC MEDICINE; THERAPEUTICS