1Eli Lilly, Indianapolis, Indiana.
2Humana Healthcare Research, Louisville, Kentucky.
J Manag Care Spec Pharm. 2019 Aug;25(8):879-887. doi: 10.18553/jmcp.2019.25.8.879.
Disease-modifying antirheumatic drugs (DMARDs) are recommended as the standard of care for patients with rheumatoid arthritis (RA) due to their ability to reduce pain and disability; however, DMARD use is low in some subgroups of the RA population.
To identify characteristics associated with DMARD use in the overall cohort of patients with RA and newly diagnosed RA patients.
This retrospective observational study used claims from a large national health plan. Use of DMARDs was measured according to the Healthcare Effectiveness Data and Information Set (HEDIS) as the proportion of patients with RA receiving DMARDs. Following HEDIS measure technical specifications, we identified patients aged 18-89 years with continuous enrollment during 2014 (measurement year) with ≥ 2 claims for RA outpatient visits and/or discharges on different dates between January and November 2014. Additionally, we identified a subset of patients newly diagnosed with RA in 2014 based on absence of any claims for RA or DMARDs in 2013. Descriptive analyses and bivariate associations were used to compare demographic and clinical characteristics of patients with RA with or without DMARD use in 2014. Health care resource utilization (HCRU) and costs were compared in 2014 for patients enrolled in Medicare Advantage Prescription Drug (MAPD) plans during both 2014 and 2015. Regression models were used to evaluate patient and provider characteristics associated with DMARD use in 2014 and the effect on HCRU and costs.
Among the 33,880 patients identified with RA in 2014, most patients received a DMARD (75.2%); 29.4% of patients newly diagnosed with RA had been treated with DMARDs in 2014. Patients with DMARD use, on average, were younger (aged 67 years ± 10.7 vs. 69 years ± 10.7) and healthier (Deyo-Charlson Comorbidity Index [DCCI] 2.4 ± 1.9 vs. 2.6 ± 2.1) and included a greater proportion of women (75.9% vs. 71.0%) than those with no DMARD use ( < 0.0001). Use of DMARDs ( < 0.0001) was associated with 14.5% fewer hospitalizations and 18.0% fewer emergency department visits. Although total costs increased by 15.0% with use of DMARDs, when the cost of DMARDs was excluded, the total cost decreased by 13.7% ( < 0.0001). Female gender (32.2%), higher claims-based index for RA severity score (47.0%), higher RxRisk-V score (26.7%), visit to a rheumatologist (34.3%), and use of glucocorticoids (17.7%) increased the odds of DMARD use ( < 0.0001). Use of certain classes of medication, such as nonsteroidal anti-inflammatory drugs (12.3%), opioids (19.5%), antidepressants (20.0%), muscle relaxants (12.5%), and anticonvulsants (15.5%), were associated with lower use of DMARDs ( < 0.0001).
We found significant differences in demographic and clinical characteristics between patients with and without DMARD use, which can potentially inform treatment decisions regarding DMARD use as deemed necessary by the provider. Future research should investigate the reasons for lack of treatment.
This study was supported by funding from Eli Lilly to Humana as a collaborative research project involving employees of both companies. Boytsov, Saverno, Zhang, and Gaich are employees of Eli Lilly. Nair, Bhattacharya, Abbott, and Dixon are employees of Humana, which received funding from Eli Lilly to complete this research.
由于疾病修饰抗风湿药物（DMARD）能够减轻疼痛和残疾，因此被推荐为类风湿关节炎（RA）患者的标准治疗方法；然而，在 RA 患者的某些亚组中，DMARD 的使用较低。
确定与 RA 患者总体队列和新诊断的 RA 患者中 DMARD 使用相关的特征。
这是一项回顾性观察性研究，使用了来自大型全国健康计划的索赔数据。DMARD 的使用根据医疗保健效果数据和信息集（HEDIS）进行衡量，即接受 DMARD 治疗的 RA 患者比例。根据 HEDIS 测量技术规范，我们确定了在 2014 年（测量年）期间连续入组、2014 年 1 月至 11 月期间有≥2 次 RA 门诊就诊和/或不同日期出院的 18-89 岁患者。此外，我们根据 2013 年没有任何 RA 或 DMARD 索赔，确定了 2014 年新诊断为 RA 的患者亚组。比较 2014 年有或没有 DMARD 使用的 RA 患者的人口统计学和临床特征。比较 2014 年和 2015 年同时参加医疗保险优势处方药（MAPD）计划的患者的医疗保健资源利用（HCRU）和费用。使用回归模型评估与 2014 年 DMARD 使用相关的患者和提供者特征以及对 HCRU 和费用的影响。
在 2014 年确定的 33880 名 RA 患者中，大多数患者接受了 DMARD（75.2%）；29.4%的新诊断为 RA 的患者在 2014 年接受了 DMARD 治疗。使用 DMARD 的患者平均年龄较小（67 岁±10.7 岁比 69 岁±10.7 岁），健康状况较好（Deyo-Charlson 合并症指数[DCCI] 2.4±1.9 比 2.6±2.1），女性比例较高（75.9%比 71.0%），而不使用 DMARD 的患者（<0.0001）。使用 DMARD（<0.0001）与住院减少 14.5%和急诊就诊减少 18.0%相关。虽然使用 DMARD 会导致总费用增加 15.0%，但当排除 DMARD 的费用时，总费用减少了 13.7%（<0.0001）。女性（32.2%）、较高的基于索赔的 RA 严重程度评分指数（47.0%）、较高的 RxRisk-V 评分（26.7%）、看风湿病医生（34.3%）和使用糖皮质激素（17.7%）增加了使用 DMARD 的几率（<0.0001）。使用某些类别的药物，如非甾体抗炎药（12.3%）、阿片类药物（19.5%）、抗抑郁药（20.0%）、肌肉松弛剂（12.5%）和抗惊厥药（15.5%），与 DMARD 使用减少相关（<0.0001）。
我们发现使用和不使用 DMARD 的患者在人口统计学和临床特征方面存在显著差异，这可能为提供者根据需要决定 DMARD 使用提供依据。未来的研究应调查缺乏治疗的原因。
这项研究得到了礼来公司向Humana 提供的资金支持，作为涉及两家公司员工的合作研究项目。Boytsov、Saverno、Zhang 和 Gaich 是礼来公司的员工。Nair、Bhattacharya、Abbott 和 Dixon 是 Humana 的员工，该公司接受了礼来公司的资金支持以完成这项研究。
