RESEARCH - Impact of managed care on the use of biologic agents for RA

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Arthritis Rheum. 2005 Jun 2;53(3):423-430 [Epub ahead of print]

Impact of managed care on the use of biologic agents for rheumatoid

arthritis.

Yelin EH, Trupin LS, Katz PP.

lind Medical Research Center for Arthritis, University of

California, San Francisco.

OBJECTIVE: To compare the use of biologic agents among persons with

rheumatoid arthritis (RA) in managed care and fee-for-service settings.

METHODS: The present study uses data from the University of California, San

Francisco RA Panel Study in which 529 patients with RA from a random sample

of northern California rheumatologists were interviewed annually between

1999 and 2002 using a structured survey instrument. Linear and logistic

regression were used to compare current utilization, initiation, and

cessation of biologic agents and other treatments among patients with RA in

managed care and fee-for-service settings, with and without adjustment for

differences in demographic and health characteristics. RESULTS: After

adjustment, patients with RA in health maintenance organizations (HMOs) were

significantly less likely to use biologic agents than those in other managed

care settings (difference of -6.6%; 95% confidence interval [95%

CI] -11.4%, -1.7%) or than those in fee-for-service settings (difference

of -12.5%; 95% CI -19.0%, -5.9%); patients in other managed care settings

and fee-for-service did not differ significantly in their use of biologic

agents. Patients with RA in HMOs were significantly less likely than those

in other managed care settings to initiate the use of biologic agents

(difference of -7.3%; 95% CI -11.5%, -3.1%); there were no other differences

between patients in HMOs and those in other managed care and fee-for-service

settings in rates of initiation or cessation of these agents. Patients with

RA in HMOs were less likely to use methotrexate, cyclooxygenase 2 (COX-2)

inhibitors, and corticosteroids than those in other managed care settings;

they were also less likely to use COX-2 inhibitors than those in

fee-for-service settings.

CONCLUSION: Patients with RA in HMOs were significantly less likely to use

biologic agents than those in other managed care and fee-for-service

settings, primarily due to lower rates of initiation.

PMID: 15934109

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5934109 & dopt=Abstract

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