Digestive Health Institute, Children's Hospital Colorado, Division of Pediatrics and Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Pediatrics. 2022 Mar 1;149(3). doi: 10.1542/peds.2021-052501.
Delays in advancing to biologic therapies are associated with adverse outcomes in inflammatory bowel disease (IBD). Insurer-mandated prior authorizations have been linked to prolonged medication initiation times. We hypothesized that prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization among children with IBD.
We performed a retrospective cohort study of 190 pediatric patients with IBD initiating biologics at a tertiary care hospital to measure the association between prior authorization, biologic initiation time (physician recommendation to first dose), and healthcare utilization (hospitalization, surgery, or emergency department visit). Demographic, insurance, and disease severity-related covariables were collected. Multivariable linear regression was used to measure the association between prior authorization and biologic initiation time. Propensity score methods were used to measure the associations between prior authorization and IBD-related healthcare utilization within 180 days and corticosteroid dependence at 90 days, with adjustment for insurance type, demographics, and disease severity-related characteristics.
Median biologic initiation time was 21 days. Prior authorization and complicated prior authorizations (requiring appeal, step therapy, or peer-to-peer review) were associated with 10.2-day (95% confidence interval [CI] 8.2 to 12.3) and 24.6-day (95% CI 16.4 to 32.8) increases in biologic initiation time, respectively. Prior authorizations increased the likelihood of IBD-related healthcare utilization within 180 days by 12.9% (95% CI 2.5 to 23.4) and corticosteroid dependence at 90 days by 14.1% (95% CI 3.3 to 24.8).
Prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization. Minimizing prior authorization-related delays may expedite biologic delivery and reduce the risk of IBD-related healthcare utilization.
在炎症性肠病 (IBD) 中，延迟使用生物疗法与不良结局相关。保险公司授权的事先授权与药物起始时间延长有关。我们假设事先授权与儿童 IBD 的生物起始时间延长和增加的 IBD 相关医疗保健利用率相关。
我们对在一家三级保健医院开始使用生物制剂的 190 名患有 IBD 的儿科患者进行了回顾性队列研究，以衡量事先授权、生物起始时间（医生建议首次剂量）和医疗保健利用率（住院、手术或急诊就诊）之间的关联。收集了人口统计学、保险和疾病严重程度相关的协变量。使用多变量线性回归来衡量事先授权与生物起始时间之间的关联。使用倾向评分方法在 180 天内衡量事先授权与 IBD 相关的医疗保健利用率之间的关联，并在 90 天内衡量与皮质类固醇依赖的关联，同时调整保险类型、人口统计学和疾病严重程度相关特征。
生物制剂起始时间的中位数为 21 天。事先授权和复杂的事先授权（需要上诉、阶梯治疗或同行评审）分别与生物制剂起始时间增加 10.2 天（95%置信区间 [CI] 8.2 至 12.3）和 24.6 天（95% CI 16.4 至 32.8）相关。事先授权使 IBD 相关医疗保健利用率在 180 天内增加了 12.9%（95% CI 2.5 至 23.4），在 90 天内增加了皮质类固醇依赖的可能性增加了 14.1%（95% CI 3.3 至 24.8）。
事先授权与生物制剂起始时间延长和增加的 IBD 相关医疗保健利用率相关。尽量减少与事先授权相关的延迟可能会加快生物制剂的输送并降低 IBD 相关医疗保健利用率的风险。
