Abstract:
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.
The American Journal of Medicine
