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.


The Impact of RA Diagnoses on Cost Related Medication Nonadherence in Older Patients: 20042007.

Harrold3,  Leslie R., Briesacher4,  Becky A., Peterson2,  Daniel, Madden1,  Jeanne, Gurwitz2,  Jerry H., Soumerai1,  Stephen B.

Harvard Medical School, Boston, MA
Meyers Primary Care Institute, Worcester, MA
UMass Medical Schl, Worcester, MA
UMass Medical School, Worcester, MA

Introduction:

The treatment of rheumatoid arthritis (RA) can involve costly medications. We sought to examine whether cost-related medication nonadherence (CRN) was higher among patients with RA as compared to those without the condition from 2004 through 2007.

Methods:

We identified a nationally-representative sample of elderly and disabled patients with rheumatoid arthritis (RA), based on two claims diagnoses (ICD-9 714.XX), and those without RA using the Medicare Current Beneficiary Survey. There were 219 to 241 RA patients and 14279 to14575 non-RA patients annually from 2004–2007 (unweighted n). We compared self-reported CRN (skipping or reducing medication doses or not obtaining prescriptions) among beneficiaries with and without RA. Using logistic regression, we examined whether there were trends over time in the occurrence of CRN among those with and without RA. Then we evaluated whether an RA diagnosis was associated with CRN after controlling for year, demographic characteristics, socioeconomic status, and comorbidities.

Results:

The unadjusted annual prevalence of CRN in 2004, 2005, 2006, and 2007 among beneficiaries with RA was 20.7%, 17.5%, 16.7%, and 15.6%, respectively, compared with 15.1%, 14.0%, 11.4%, and 10.6% among beneficiaries without RA (statistically significant differences between RA vs non-RA in 2004 and 2006). In RA patients, the absolute decrease in CRN 2004 to 2007 was 5.1% and relative decrease was 24.6%, while among non-RA patients these were 4.5% and 29.8%, respectively.

Figure 1. The prevalence of cost-related medication nonadherence among elderly Medicare beneficiaries with a diagnosis of rheumatoid arthritis (RA) versus those without (non-RA), 2004–2007.

The trend in CRN over time was not significant for those with RA (p=0.23) but was for those without the condition (p < 0.0001). The diagnosis of RA increased the likelihood of CRN (OR 1.27; 95% CI 1.01–1.60) in adjusted analyses.

Conclusions:

CRN is a persistent problem for older adults, especially those with RA. While there have been decreases in CRN over time related to the Medicare Replacement Drug Demonstration program and Medicare Part D, substantial numbers of RA patients continue to report problems affording their medications.

To cite this abstract, please use the following information:
Harrold, Leslie R., Briesacher, Becky A., Peterson, Daniel, Madden, Jeanne, Gurwitz, Jerry H., Soumerai, Stephen B.; The Impact of RA Diagnoses on Cost Related Medication Nonadherence in Older Patients: 20042007. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :791
DOI: 10.1002/art.28559

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