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APHA Scientific Session and Event Listing

Rahul Khanna and Michael Smith. Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, P.O. Box 9510, Morgantown, WV 26506-9510, 304-293-6991, rkhanna@hsc.wvu.edu

Background: Rheumatoid Arthritis (RA) is a chronic autoimmune disorder that affects nearly 2.5 million Americans, and exerts a significant burden to society in terms of morbidity as well as direct and indirect costs. Lower socioeconomic status has been identified as a risk factor for RA. Few studies have reported the rates of health services use for RA among low-income groups. Objective: To assess the utilization patterns and costs for medical services and prescription medications for RA treatment among recipients enrolled in a state Medicaid program. Methods: A cross-sectional, descriptive analysis of a state Medicaid administrative claims dataset was conducted. Medical services claims with a primary diagnosis code (ICD-9-CM 714.00) for RA during calendar year 2003 were extracted. De-identified unique recipient numbers obtained from these claims were used to extract corresponding claims for prescription medications. Prevalence and healthcare use rates were calculated by demographic categories. Costs were reported from the perspective of Medicaid. Results: There were 1,642 recipients identified with RA, at an overall rate of 4.4/1,000 recipients. The highest rates of RA by demographic groups occurred among females (5.6/1,000), whites (4.2/1,000), and recipients between 45-64 years of age (16.8/1,000). Office visits accounted for the majority of medical services encounters (98%), at a rate of 19.1 visits/1,000 recipients. Patterns of prescription medication use showed that 62% of the sample had at least one prescription claim for a narcotic analgesic, 56% for an NSAID, 47% for an oral steroid, 38% for a DMARD, and 11% for a biologic agent. Approximately 44.3% of the recipients received three or more classes of medications to treat RA in the given year. Medicaid paid approximately $1,976/recipient for RA-related medical services and prescriptions during the year. Dollars paid for office visits accounted for 67% of the medical services costs at an average of $57 per visit. Prescription claims accounted for 81% of the total cost of RA care. Although biologic agents constituted a small proportion of prescription claims for RA (4.6%), they accounted for the largest proportion of prescription costs (53%). Conclusion: The prevalence and healthcare services utilization patterns for RA among Medicaid recipients differed by demographic characteristics. Medical services for RA occurred mostly in the physician office setting, and prescription medications to treat RA accounted for a majority of the total costs of care. A majority of recipients with RA received prescriptions for three or more classes of RA-related drugs.

Learning Objectives:

• 1.Describe the prevalence of Rheumatoid Arthritis (RA) by various demographic groups among a state Medicaid population.
• 2.Describe the rates of medical services use for RA by various demographic groups.
• 3.Describe the patterns of prescription medication use for RA treatment.

Presenting author's disclosure statement:

Not Answered