Categorization of infliximab dose changes and healthcare utilization and expenditures for patients with rheumatoid arthritis in commercially insured and Medicare-eligible populations
Categorization of infliximab dose changes and healthcare utilization and expenditures for patients with rheumatoid arthritis in commercially insured and Medicare-eligible populations
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DOI：
10.1185/03007990802598736
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发表时间：
2009-02-01
影响因子：
2.3
通讯作者：
Rahman, Mirza
中科院分区：
文献类型：
--
作者：
Nair, Kavita V.;Tang, Boxiong;Rahman, Mirza
目的：评估英夫利西单抗剂量的变化如何影响资源利用和支出的患者类风湿关节炎（RA）研究设计和方法：回顾性分析使用索赔从1999年1月1日至2005年3月31日在MedStat MarketScan数据库中的RA患者谁增加，减少，或没有改变英夫利西单抗剂量在1年内开始治疗。合格标准包括至少一次诊断为RA的索赔，并且在索引英夫利西单抗索赔前6个月内没有生物治疗，在索引日期之前6个月和之后12个月内连续参加健康计划（商业或医疗保险），以及连续三次英夫利西单抗输注。指数和最终英夫利西单抗剂量估计索赔data.Results：数据包括1678个商业保险的患者和616个Medicare合格的患者; 45.4%和39.3%，分别有剂量增加，24.7%和43.2%，分别有剂量减少，29.9%和17.5%，分别没有改变剂量。总体而言，与两个队列的剂量降低组相比，剂量增加组的资源利用率较高，而剂量不变组的资源利用率较低。两个队列中剂量增加组的医疗费用也最高。在两个cohols.Conclusions：剂量的增加是最常见的剂量变化的商业队列，而剂量的减少是最常见的剂量变化的医疗保险合格的队列。剂量增加的患者的利用率和支出最高，而剂量不变的患者的利用率和支出水平最低。需要检查这种利用的性质，以更好地了解剂量变化如何影响医疗利用。剂量变化定义为首次和最终剂量之间的差异，可能未捕获中期剂量的变化。
Objective: To evaluate how changes in infliximab dose influence resource utilization and expenditures for patients with rheumatoid arthritis ( RA).Research design and methods: A retrospective analysis using claims from January 1, 1999 through March 31, 2005 in the MedStat MarketScan databases for RA patients who had an increase, decrease, or no change in infliximab dose within 1 year of initiating therapy. Eligibility criteria included at least one claim with a diagnosis of RA and no biologic treatment within 6 months before the index infliximab claim, continuous health plan enrollment (commercial or Medicare) for 6 months before and 12 months after the index date, and three consecutive infliximab infusions. The index and final infliximab doses were estimated from claims data.Results: Data were included for 1678 commercially insured patients and 616 Medicare-eligible patients; 45.4% and 39.3%, respectively, had an increase in dose, 24.7% and 43.2%, respectively, had a decrease in dose, and 29.9% and 17.5%, respectively, had no change in dose. Overall, resource utilization was higher in the increase-in-dose groups and lower in the no change-in-dose groups when compared with the decrease-in-dose groups for both cohorts. Medical costs were also highest for the increase-in-dose groups for both cohorts. Pharmacy expenditures for the no-change-in-dose groups were lower than the decrease-in-dose groups in both cohorts.Conclusions: An increase in dose was the most common dose change for the commercial cohort, while a decrease in dose was the most common dose change for the Medicare-eligible cohort. Patients with an increase in dose had the highest utilization and expenditures while those with no change in dose had the lowest levels. The nature of this utilization needs to be examined to better understand how dosing changes may influence medical utilization. Changes in dose were defined by the difference between the first and final doses and may not have captured changes in interim doses.