Evaluation of Access Disparities to Biologic Disease-Modifying Antirheumatic Drugs in Rural and Urban Communities

Peterman, Nicholas J; Vashi, Aksal; Govan, Devan; Bhatia, Amrit; Vashi, Tejal; Kaptur, Brad; Yeo, Eunhae; Gizinski, Alison M.

doi:10.7759/cureus.26448

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…Despite ACA reforms, most rheumatologists practice in metropolitan areas, and the majority of nonurban communities lack rheumatologists . One study reported that the regions with lowest access to bDMARDs were nonurban . Although one might anticipate a greater rate of surgery in populations with less access to novel treatment, such as bDMARDs, this correlation has not been found .…”

Section: Discussionmentioning

confidence: 99%

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Dwivedi,

Cichocki,

et al. 2024

JAMA Surg

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ImportanceRheumatoid arthritis (RA) has severe functional and economic consequences. The implications of the Patient Protection and Affordable Care Act (ACA) and demographic factors for access to surgical treatment are unclear.ObjectiveTo investigate factors associated with time to RA hand surgery, surgical incidence, and cost after implementation of the ACA.Design, Setting, and ParticipantsThis cross-sectional study used insurance data from the IBM MarketScan Research Databases from 2009 through 2020 to compare time to surgery, surgical incidence, and treatment cost for RA of the hand before and after ACA implementations. Included patients were 18 years or older with a new diagnosis for RA of the hand and at least 1 procedural code for arthroplasty, arthrodesis, tenolysis, tendon repair, or tendon transfer. Patients with coexisting inflammatory arthritis diagnoses were excluded. Demographic variables analyzed included patient sex, age at index date, residence within or outside a metropolitan statistical area (MSA; hereafter urban or nonurban), insurance and health plan type, Social Deprivation Index, Elixhauser Comorbidity Index score, and Rheumatic Disease Comorbidity Index. Data analysis occurred from October 2022 to April 2023.ExposuresSurgery for RA of the hand during the pre-ACA (before 2014) vs post-ACA (2014 or later) periods.Main Outcomes and MeasuresTime to surgery, surgical incidence, and cost of treating RA in patients undergoing hand surgery for RA.ResultsAmong 3643 patients (mean [SD] age, 57.6 [12.3] years) who underwent hand surgery for RA, 3046 (83.6%) were women. Post-ACA passage, 595 (86.2%) patients who resided in urban areas had a significantly lower time to surgery than those who did not (−70.5 [95% CI, −112.6 to −28.3] days; P &lt; .001). Among urban patients, the least socially disadvantaged patients experienced the greatest decrease in time to surgery after ACA but the change was not statistically significant. For all patients, greater social disadvantage (ie, a higher SDI score) was associated with a longer time to surgery in the post-ACA period; for example, compared with the least socially disadvantaged group (SDI decile, 0-10), patients in SDI decile 10 to 20 waited an additional 254.0 days (95% CI, 65.2 to 442.9 days; P = .009) before undergoing surgery. Compared with the pre-ACA period, the mean surgical incidence in the post-ACA period was 83.4% lower (162.3 vs 26.9 surgeries per 1000 person-years; P &lt; .001), and surgical incidence was 86.3% lower in nonurban populations (27.2 vs 3.7 surgeries per 1000 person-years; P &lt; .001) but only 82.8% lower in urban populations (135.1 vs 23.2 surgeries per 1000 person-years; P &lt; .001). Per capita total costs of all treatment related to RA of the hand decreased in the post-ACA period but the change was not statistically significant. Insurer-paid costs were lower in the post-ACA period but the change was not statistically significant. Out-of-pocket expenses did not change.Conclusions and RelevanceFindings of this cross-sectional study suggest that after ACA passage, disparities exist in access to timely, cost-effective hand surgery for RA. Increased access to surgical hand specialists is needed for nonurban residents and those with greater social deprivation, along with insurance policy reforms to further decrease out-of-pocket spending for RA hand surgery.

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Section: Discussionmentioning

confidence: 99%

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Dwivedi,

Cichocki,

et al. 2024

JAMA Surg

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“…For example, urban areas in the US frequently contain a greater proportion of people under 65 years of age than rural areas, while the Commercial database includes the under-65 working population versus Medicare, which includes retirees [ 37 , 38 ]. Potential disparities in access to biologics within urban versus non-urban settings may also be a contributing factor [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Biologic use and treatment patterns in patients with chronic rhinosinusitis with nasal polyps: a US real-world study

Silver,

Packnett,

Park

et al. 2023

Allergy Asthma Clin Immunol

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Background Several biologics are now approved in the US as add-on treatments for chronic rhinosinusitus with nasal polyps (CRSwNP). This cross-sectional, retrospective, real-world study aimed to characterize treatment patterns and identify predictors of biologic use among patients with CRSwNP. Methods Adults in the Merative MarketScan Commercial and Medicare Supplemental Databases with medical claims for CRSwNP were identified June 2018–June 2019 (identification period [IP]). Patient characteristics were collated in the IP and treatment pattern data during the IP plus the following year (July 2019–June 2020; observation period [OP]). Data were stratified by sinus surgery and biologic use. Results Of the 5997 eligible patients identified (58% male, mean age 48.1 years), 10.7% (n = 642) used biologics during the OP. More biologic users had common respiratory conditions than non-users, particularly asthma (89.1% vs 35.0%; P < 0.001). Biologic users had fewer diagnostic services but more drug-related services than non-users. Only 11.6% of patients who had sinus surgery used biologics, with most (56.1%) having their first biologic dose before sinus surgery and 12.5% ≤ 30 days after. Oral corticosteroid (OCS) use was higher in biologic users than non-users (all patients: 68.8% vs 42.5%; P < 0.001) and in those with/without sinus surgery. Comorbidities, prior OCS/doxycycline use, and age (< 65 years) increased the odds of biologic use, with asthma increasing the odds 5.46 times (P < 0.001). Conclusions Biologic use was more common before first/next sinus surgery and in patients with high unmet need, elucidating predictors of biologic use that could be used in clinical practice.

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“…Access to DMARDs for the treatment of immunologic conditions has been shown to vary by demographics, potentially contributing to disparities in outcomes and disease severity in different racial/ethnic populations [ 13 , 14 ]. Literature suggests that patients with rheumatoid arthritis [ 15 , 16 ] and psoriasis [ 17 ] have care delivery disparities, resulting in greater disease severity and poorer quality of life [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Disparities in Treatment Initiation Among Patients with Newly Diagnosed Psoriatic Arthritis: A Retrospective Medicaid Claims Database Study

et al. 2023

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Introduction In patients with psoriatic arthritis (PsA), potential differences in care by race/ethnicity have not been well studied. Methods This retrospective, observational cohort analysis utilized the IBM MarketScan ® Multi-State Medicaid database. Patients aged ≥ 18 years with two or more PsA-related claims between January 1, 2010 and December 31, 2019, and ≥ 12 months of continuous enrollment before the first diagnosis of PsA (index date) were included. Outcomes evaluated were the use of disease-modifying antirheumatic drugs (DMARDs) overall and by type (conventional synthetic, biologic, targeted synthetic) within 12 months following initial PsA diagnosis, as well as the time to DMARD initiation after initial PsA diagnosis, stratified by race/ethnicity. Multivariate Cox proportional hazards models were used to assess potential associations between patient baseline characteristics and time to DMARD initiation. Results Among patients with newly diagnosed PsA ( N = 3432), the mean age was 44.4 years, 69.9% were female, 77.4% were White, and 10.1% were Black. Of the 2993 patients with at least 12 months of follow-up, fewer Black patients received any DMARD therapy compared with White patients (68.4 vs. 76.4%, respectively, p = 0.002), and, specifically, a lower percentage of Black patients received biologic DMARDs compared with White patients (33.6 vs. 42.6%, respectively, p = 0.003). After adjusting for baseline characteristics, Black patients had significantly longer time to initiation of any DMARD (HR [95% CI] 0.82 [0.71–0.94]) and biologic DMARD (0.84 [0.71–0.99]) compared with White patients. Other baseline variables such as older age, anxiety, and hepatitis C were also significantly associated with longer time to any DMARD initiation after initial PsA diagnosis. Conclusions Time to treatment initiation was significantly longer in Black patients compared with White patients with newly diagnosed PsA. These findings suggest care delivery disparities in patients with PsA and highlight the need for future studies to understand factors that drive the observed differences in drug therapy by race/ethnicity. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-023-00580-y.

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Evaluation of Access Disparities to Biologic Disease-Modifying Antirheumatic Drugs in Rural and Urban Communities

Cited by 4 publications

References 23 publications

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Biologic use and treatment patterns in patients with chronic rhinosinusitis with nasal polyps: a US real-world study

Racial and Ethnic Disparities in Treatment Initiation Among Patients with Newly Diagnosed Psoriatic Arthritis: A Retrospective Medicaid Claims Database Study

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