Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by/4.0
Related items
Showing items related by title, author, creator and subject.
-
Utilization and Cost of the Biologic Disease Modifying Anti-rheumatic Drugs among Medicare Beneficiaries with Rheumatoid ArthritisBackground: Disease modifying anti-rheumatic drugs (DMARDs) are essential for symptom control among rheumatoid arthritis (RA) patients. Biologic DMARDs are expensive and typically used among moderate to severe RA patients. The prevalence of RA is higher among Medicare beneficiaries compared to the rest of the population in the U.S (2% vs. 0.6%). The coverage rules of Medicare, in addition to access factors and patient preferences, may influence the use of facility-administered, infusible biologics (Part B covered) and home-administered self-injectable/oral biologics (Part D covered). However, there is limited information about utilization patterns of biologic DMARDs by route of administration and their impact on Medicare spending overall. The goals of this dissertation were to identify patient factors and healthcare expenditure associated with biologic DMARD use by route of administration among Medicare beneficiaries with RA. Methods: The study population consisted of Medicare beneficiaries with RA from the 5% random sample of the Chronic Conditions Warehouse database from 2006-2015. First, the study analyzed patient-level factors associated with biologic DMARD use by route of administration using generalized estimating equations. Second, adherence (PDC>80%), discontinuation, and switching patterns for biologic DMARDs were measured, accounting for patient level-factors , using logistic regression, Cox proportional hazards models, and chi-square analyses, respectively. Third, the study compared annualized average healthcare costs of patients who were adherent to versus non-adherent to biologic DMARDs. Results: Among Medicare beneficiaries diagnosed with RA who received DMARD treatment (n=46,002), 71.8% (n=33,028) used traditional DMARDs, and among biologic DMARD users (n=12,931), twice as many used infusible biologics (18.3%, n=8,436) compared to self-injectable/oral (9.9%, n=4,538). Beneficiaries who were low-income subsidy (LIS) recipients i.e. who had lower out-of-pocket costs for using biologics, (compared to non-LIS) had 4.54 times higher odds of using self-injectable/oral biologics (95% CI: 4.2 - 5.0) and 5% lower odds of discontinuing biologic DMARDs (OR=0.94, 95% CI: 0.91-0.97). The total healthcare cost was lower among adherent compared to non-adherent infusible biologic DMARD users ($33,797 vs. $90,181; p<0.001) and among adherent vs. non-adherent self-injectable/oral biologic DMARD users ($64,977 vs. $80.908; p<0.05). Conclusions: Adherence and cost savings generated, as a result, varied by the biologic DMARD route of administration. Additionally, beneficiaries' LIS status was associated with the route of administration used and the discontinuation rates, indicating an association with their out-of-pocket costs. These findings are relevant to the discussion about the proposed transition of Part B covered infusible medications under the Part D which is projected to increase the beneficiary out-of-pocket cost. The evidence on adherence can also be used for value-based insurance design involving RA biologics. Future research could leverage the findings from this study to additionally explore how biosimilar products may impact overall biologic utilization and RA treatment spending.
-
Race and socioeconomic status as predictors of utilization and need for total knee arthroplasty for knee osteoarthritis: Data from the OsteoArthritis Initiative studyObjective: Previous studies consistently report reduced rates of utilization of total knee arthroplasty (TKA) among black U.S. adults as compared with whites. This study assessed whether differences in TKA utilization rates between blacks and whites persist after including estimates of socioeconomic status and theoretical candidacy for joint replacement surgery. This study also examined whether blacks and whites differ in rate of reaching candidacy for TKA, and whether socioeconomic factors are related to reaching VTKA. Methods: This study employed data from the OsteoArthritis Initiative study. Study participants were black and white adults enrolled in the OAI study between the ages of 49 and 79 at baseline. Study aims were achieved using a discrete survival approach. Cox-analogue proportional hazards models were employed using a log minus log link to produce hazard ratios specific to respective intervals between time points. Models were fit using General Estimating Equations. Results: Results showed that blacks were significantly less likely to undergo total knee arthroplasty than whites, even after including estimates of baseline differences in BMI and number of comorbidities, baseline need for TKA, and socioeconomic status (education and income) (e^(β)=0.50, p=0.0016). Individuals who met need for TKA criteria at baseline were significantly more likely to undergoing TKA than those who did not (e^(β)=8.25, p<0.0001). Results also revealed race not to be a significant predictor of reaching need for TKA after including estimates of baseline differences in BMI and number of comorbidities. These findings persisted even with the inclusion of socioeconomic variables. Conclusions: Findings confirmed that substantial racial differences in utilization of TKA exist. The inclusion of socioeconomic status measures accounted for only a small proportion of the difference between blacks and whites in terms of TKA utilization (e^(β)=0.41 versus e^(β)=0.50). Racial differences in progression of knee OA to virtual TKA were also found, although race became non-significant after accounting for baseline differences in BMI categories (overweight and obese). Results suggest that other factors not captured in this study differentially influence the rate of TKA utilization among black and white U.S. adults.
-
An empirical investigation of practical reasoning in the construction of beliefs regarding medication by arthritis patientsPatient drug consumption behavior has an impact on the outcomes, effectiveness, and costs associated with therapy. Patients' beliefs influence their health behaviors and little is known about how patients form beliefs. Therefore, an understanding of belief formation will assist professionals in developing interventions that effectively influence health behaviors. This study used the model of belief processing proposed by Smith, Benson, and Curley (1991) to examine the belief formation used by arthritis patients regarding their medication. Study subjects included arthritis patients from a health maintenance organization population. Forty-six subjects were randomly assigned to four groups. Three groups received different levels of information about a drug and were asked about their beliefs regarding its helpfulness. Subjects in the final group were asked about their beliefs regarding the helpfulness of nabumetone, a drug they were currently taking. Verbal protocols were independently coded by three coders using operational definitions from the literature and constructs in the model. The codes were tallied and the hypotheses were tested using ANOVA and MANOVA. Subjects used more practical reasoning than judgments or calculation to form their beliefs. Most subjects used responses that corresponded with two or more modules of the model. Contrary to expectations, providing more information did not influence the use of practical reasoning or judgments. Amount of information also did not influence subjects' use of most argument types. These findings suggest that (1) patients use practical reasoning rather than formal logical reasoning to form beliefs about the helpfulness of medications; (2) the "expectancy x value" approach is not appropriate in modeling the reasoning patients use to form beliefs about their medications; (3) the Smith, Benson, and Curley model contains constructs used by patients to form beliefs; (4) experience decreases the use of authoritative arguments in forming beliefs; and (5) increased information may influence beliefs, but it does not seem to influence the processing used to form beliefs.
