Khanna Rahul, Smith Michael J
Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV 26506, USA.
Clin Ther. 2007 Nov;29(11):2456-67. doi: 10.1016/j.clinthera.2007.11.009.
Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by inflammation of synovial tissues that leads to joint swelling, stiffness and pain, and progressive joint destruction. There is currently limited information about demographic differences in the prevalence of RA and the utilization and costs of RA-related prescription medications and medical services among low-income populations.
This study assessed the prevalence of RA and the utilization and costs of RA-related medical services and prescription medications among recipients enrolled in a state Medicaid program.
A retrospective, cross-sectional, descriptive analysis of West Virginia (WV) Medicaid fee-for-service administrative claims data was conducted. Medical services claims for recipients aged between 15 and 64 years with a primary diagnosis code for RA during the calendar year 2003 were extracted. Unique recipient numbers obtained from these claims were used to extract the corresponding prescription claims. Prevalence and health care use rates were calculated by demographic categories. Costs were reported from the perspective of WV Medicaid.
A total of 143,211 recipients aged between 15 and 64 years received WV Medicaid benefits. Among these, 1157 recipients (0.81%) had > or = 1 medical service claim (hospitalization, emergency department visit, or office visit) with a primary diagnosis of RA. The mean (SD) age of the sample was 47 (11.1) years. The highest rates of RA by age, sex, and race occurred among recipients aged 45 to 64 years (16.4:1000), females (10.1:1000), and whites (8.2:1000). Office visits accounted for the majority of medical services visits and costs. Among the sample, 67.8% had > or =1 prescription claim for a narcotic analgesic, 58.8% for an NSAID, 48.3% for an oral steroid, 40.1% for a disease-modifying antirheumatic drug, and 12.4% for a biologic agent. Medicaid paid a mean of $2379 per recipient for RA-related health care services. Prescription claims accounted for 74.6% of the total cost of RA care. Biologic agents accounted for the largest proportion (54.1% ) of prescription costs.
The prevalence of RA and rates of health care services utilization for RA among recipients of WV Medicaid differed with regard to demographic characteristics. Utilization of RA-related prescription medication among recipients varied by pharmacotherapy class. This study presents baseline information that might be used as a model for future surveillance RA studies using payer administrative datasets.
类风湿性关节炎（RA）是一种慢性自身免疫性疾病，其特征为滑膜组织炎症，可导致关节肿胀、僵硬和疼痛，以及进行性关节破坏。目前，关于低收入人群中RA患病率以及RA相关处方药和医疗服务的使用情况及费用方面的人口统计学差异信息有限。
本研究评估了参加州医疗补助计划的人群中RA的患病率以及RA相关医疗服务和处方药的使用情况及费用。
对西弗吉尼亚州（WV）医疗补助按服务付费行政索赔数据进行回顾性横断面描述性分析。提取了2003年日历年期间15至64岁、主要诊断代码为RA的接受者的医疗服务索赔。从这些索赔中获得的唯一接受者编号用于提取相应的处方索赔。按人口统计学类别计算患病率和医疗保健使用率。费用从WV医疗补助的角度进行报告。
共有143,211名15至64岁的接受者获得了WV医疗补助福利。其中，1157名接受者（0.81%）有≥1项主要诊断为RA的医疗服务索赔（住院、急诊就诊或门诊就诊）。样本的平均（标准差）年龄为47（11.1）岁。按年龄、性别和种族划分，RA发病率最高的是45至64岁的接受者（16.4:1000）、女性（10.1:1000）和白人（8.2:1000）。门诊就诊占医疗服务就诊和费用的大部分。在样本中，67.8%有≥1项麻醉性镇痛药的处方索赔，58.8%有非甾体抗炎药的处方索赔，48.3%有口服类固醇的处方索赔，40.1%有改善病情的抗风湿药的处方索赔，12.4%有生物制剂的处方索赔。WV医疗补助为每位接受者的RA相关医疗保健服务平均支付2379美元。处方索赔占RA治疗总费用的74.6%。生物制剂占处方费用的比例最大（54.1%）。
WV医疗补助接受者中RA的患病率以及RA医疗服务的使用率在人口统计学特征方面存在差异。接受者中RA相关处方药的使用因药物治疗类别而异。本研究提供了基线信息，可作为未来使用支付方行政数据集进行RA监测研究的模型。
