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Health care utilization and expenditures among adults with rheumatoid arthritisusing specialty pharmaceuticals

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Park T1. Res Social Adm Pharm. 2018 Sep 12. pii: S1551-7411(18)30312-7. doi: 10.1016/j.sapharm.2018.09.003. [Epub ahead of print]

Abstract

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1 Pharmacy Administration, St. Louis College of Pharmacy, St. Louis, MO, 63110, USA; Center for Health Outcomes Research and Education, St. Louis College of Pharmacy, St. Louis, MO, 63110, USA. Electronic address: Taehwan.Park@stlcop.edu.

Abstract

BACKGROUND: Despite the rising popularity of using specialty medications for patients with rheumatoid arthritis (RA), little is known about the use or spending on medical services among these patients.

OBJECTIVE: The objective of this study was to investigate health care utilization and expenditures among patients with RA using specialty medications compared with those using non-specialty (i.e., traditional) medications.

METHODS: This was a retrospective cohort study using Medical Expenditure Panel Survey data from 2009 through 2015. Health care use and expenditures were examined using a (zero-truncated or zero-inflated) negative binomial model and a generalized linear model with a log link function and gamma distribution (or a two-part model).

RESULTS: Compared to patients with RA who were traditional medication users (TMUs), those categorized as specialty medication users (SMUs) were prescribed about 24% fewer medications (incidence rate ratio [IRR] = 0.76, 95% CI = 0.66-0.89) and received fewer office-based visits (IRR = 0.84, 95% CI = 0.70-0.99). Although SMUs' spending on emergency department visits was lower, their spending on total health care was $14,570 higher than that of TMUs. Compared with TMUs, users of both specialty and traditional medications (BMUs) had fewer emergency department visits (IRR = 0.57, 95% CI = 0.39-0.81) with less spending on emergency service use. Overall, BMUs' total health care spending was $5720 higher than TMUs' total spending.

CONCLUSIONS: There were some differences in health care use and expenditures for treating RA between patients using specialty medications and those using traditional medications. Total health care spending was higher for SMUs/BMUs despite their less frequent use of some types of medical services and lower spending on emergency department visits, because of the high cost of specialty medications for RA. The high costs of specialty medications implies the importance of the efficient use of these medications.