Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Association of Patient Cost-Cutting Behaviors with Clinical Outcomes, Health Status, and Lost Work Productivity in Individuals with Rheumatoid Arthritis.
Bolge1, Susan C., Naim2, Ahmad B., Carter2, Chureen, DiBonaventura3, Marco, Ingham2, Mike
In an effort to reduce rising healthcare costs, there has been a trend in managed care toward greater patient cost sharing. However, in this time of economic recession, high costs may necessitate cost-cutting decisions by patients, especially those with multiple, costly, chronic conditions. This study seeks to quantify cost-cutting behaviors in patients with rheumatoid arthritis (RA) and assess the association of these behaviors with patient-reported clinical outcomes, health status, and work productivity loss.
In August 2009, individuals aged >=18 and reporting an RA diagnosis completed a cross-sectional, self-administered, Internet-based questionnaire. Cost-cutting behaviors were assessed for the prior six months. Differences in outcomes were compared between patients with identified cost-cutting behaviors and those without. Patient-reported clinical outcomes included the Health Assessment Questionnaire (HAQ) and severity of morning stiffness, fatigue, and pain, measured as 1=none experienced to 10=severe. Health status was assessed using the SF-36, and work productivity loss was assessed using the Work Productivity and Activity Impairment questionnaire. Patient demographics and comorbidities were adjusted using linear regression for clinical outcomes and health status and negative binomial regression for lost work productivity.
Of 1580 patients, 41.6% (n=658) reported at least one cost-cutting behavior. The most frequently reported behaviors were delaying RA related physician visits (59.0%), taking RA prescription medication less often (25.7%), and reducing number of RA prescriptions filled (22.9%). After adjustment, cost-cutting behavior was associated with greater functional disability (HAQ: regression coefficient b=0.19, P<0.001); severity of morning stiffness (b=0.76, P<0.001), fatigue (b=0.80, P<0.001), and pain (b=0.84, P<0.001); and poorer health status (SF-36 physical component summary: b=-1.75, P<0.001 and mental component summary: b=-3.33, P<0.001). Among the employed, patient cost-cutting behaviors were associated with 1.39 times (P<0.001) the amount of overall work impairment compared to those without.
A substantial proportion of RA patients engage in cost-cutting behaviors which are associated with worsening patient-reported clinical outcomes, poorer health status, and decreased work productivity; however, due to the cross-sectional nature of the study, the direction of these associations cannot be determined. Further research is needed to investigate the potential impact of patient cost sharing on clinical effectiveness and disease progression markers.
To cite this abstract, please use the following information:
Bolge, Susan C., Naim, Ahmad B., Carter, Chureen, DiBonaventura, Marco, Ingham, Mike; Association of Patient Cost-Cutting Behaviors with Clinical Outcomes, Health Status, and Lost Work Productivity in Individuals with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :51