Dowell Sharon, Swearingen Christopher J, Pedra-Nobre Manuela, Wollaston Dianne, Najmey Sawsan, Elliott Cynthia Lawrence, Ford Theresa Lawrence, North Heather, Dore Robin, Dolatabadi Soha, Ramanujam Thaila, Kennedy Stacy, Ott Stephanie, Jileaeva Ilona, Richardson Amina, Wright Grace, Kerr Gail S
Howard University College of Medicine, Washington, DC.
New York University, Manhattan, New York.
ACR Open Rheumatol. 2023 Aug;5(8):381-387. doi: 10.1002/acr2.11575. Epub 2023 Jun 19.
To evaluate the regional variation of cost sharing and associations with rheumatoid arthritis (RA) disease burden in the US.
Patients with RA from rheumatology practices in Northeast, South, and West US regions were evaluated. Sociodemographics, RA disease status, and comorbidities were collected, and Rheumatic Disease Comorbidity Index (RDCI) score was calculated. Primary insurance types and copay for office visits (OVs) and medications were documented. Univariable pairwise differences between regions were conducted, and multivariable regression models were estimated to evaluate associations of RDCI with insurance, geographical region, and race.
In a cohort of 402 predominantly female, White patients with RA, most received government versus private sponsored primary insurance (40% vs. 27.9%). Disease activity and RDCI were highest for patients in the South region, where copays for OVs were more frequently more than $25. Copays for OVs and medications were less than $10 in 45% and 31.8% of observations, respectively, and more prevalent in the Northeast and West patient subsets than in the South subset. Overall, RDCI score was significantly higher for OV copays less than $10 as well as for medication copays less than $25, both independent of region or race. Additionally, RDCI was significantly lower for privately insured than Medicare individuals (RDCI -0.78, 95% CI [-0.41 to -1.15], P < 0.001) and Medicaid (RDCI -0.83, 95% CI [-0.13 to -1.54], P = 0.020), independent of region and race.
Cost sharing may not facilitate optimum care for patients with RA, especially in the Southern regions. More support may be required of government insurance plans to accommodate patients with RA with a high disease burden.
评估美国类风湿关节炎（RA）成本分担的地区差异及其与疾病负担的关联。
对来自美国东北部、南部和西部风湿病诊所的类风湿关节炎患者进行评估。收集社会人口统计学信息、类风湿关节炎疾病状态和合并症，并计算风湿性疾病合并症指数（RDCI）得分。记录主要保险类型以及门诊就诊（OV）和药物的自付费用。进行地区间的单变量成对差异分析，并估计多变量回归模型以评估RDCI与保险、地理区域和种族的关联。
在一个以女性为主的402例白人类风湿关节炎患者队列中，大多数人接受政府资助而非私人资助的主要保险（40%对27.9%）。南部地区患者的疾病活动度和RDCI最高，该地区门诊就诊自付费用超过25美元的情况更为常见。在45%和31.8%的观察病例中，门诊就诊和药物的自付费用分别低于10美元，且在东北部和西部患者亚组中比南部亚组更为普遍。总体而言，无论地区或种族，门诊自付费用低于10美元以及药物自付费用低于25美元时，RDCI得分均显著更高。此外，独立于地区和种族，私人保险患者的RDCI显著低于医疗保险患者（RDCI -0.78，95%置信区间[-0.41至-1.15]，P < 0.001）和医疗补助患者（RDCI -0.83，95%置信区间[-0.13至-1.54]，P = 0.020）。
成本分担可能无法为类风湿关节炎患者提供最佳护理，尤其是在南部地区。政府保险计划可能需要提供更多支持，以照顾疾病负担较重的类风湿关节炎患者。
