Health services research and policy studies

Current Opinion in Rheumatology

Volumn 8, Issue 2, 1996, Pages 106-109

  Prashker, Mark J ^a  

^a Edith Nourse Rogers Memorial VA Hospital   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEALTH CARE ACCESS; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH MAINTENANCE ORGANIZATION; HUMAN; PRIORITY JOURNAL; REVIEW; RHEUMATIC DISEASE; TREATMENT OUTCOME;

EID: 0029999090     PISSN: 10408711     EISSN: None     Source Type: Journal    
DOI: 10.1097/00002281-199603000-00004     Document Type: Review

References (8)

1. Reisine S, Fifield J: Health insurance problems among insured rheumatoid arthritis patients. Arthritis Care Res 1995, 3:155-160. The authors investigated both the limitations in insurance coverage and the financial impact of these limitations among a sample of patients with rheumatoid arthritis. Study participants were more likely to be currently enrolled in an HMO or preferred provider organization compared with 5 years ago. Twenty-one percent of the patients said they had insurance limitations because they had arthritis as a preexisting condition, and 11% stated that they had been denied health insurance.
2. Yelin E, Bernhard G, Pflugrad D: Access to medical care among persons with musculoskeletal conditions: a study using a random sample of households in San Mateo County, California. Arthritis Rheum 1995, 38:1128-1133. The authors studied access to medical services among patients with rheumatic conditions in a random population sample and found that 86% of all individuals with musculoskeletal problems had seen a physician. They also found that patients with health insurance were much more likely to have seen a physician than those without health insurance, indicating that patients seem to have good access to medical care providers for musculoskeletal problems. Only 6.5% of the patients who had consulted a physician had ever seen a rheumatologist.
3. Reisine S, McQuillan J, Fifield J: Predictors of work disability in rheumatoid arthritis patients: a five-year follow-up. Arthritis Rheum 1995, 38:1630-1637. Using a subsample of patients from a national sample of private practice rheumatology patients, the authors collected data by telephone interview and from physicians' written clinical assessments. Significant predictors of work disability in this cohort were age, number of deformed joints, number of joints with flare, complexity of work, and the patient's desire to remain employed. The risk of becoming work disabled in 5 years was predicted more by clinical status at entry into the study than it was by work structure.
4. Smalley WE, Griffin MR, Fought RL, Sullivan L, Ray WA: Effect of a prior-authorization requirement on the use of nonsteroidal anti-inflammatory drugs by Medicaid patients. N Engl J Med 1995, 332:1612-1617. The authors examined how the implementation of a prior authorization policy affected the use of nongeneric NSAIDs in the Medicaid program in Tennessee and found that expenditures decreased by 53% during the 2-year period following institution of this change, resulting in an estimated savings of $12.8 billion. The authors did not find any increase in Medicaid expenditures for other medical care and conclude that the use of prior authorization may be highly cost-effective with regard to expenditures for medications such as NSAIDs, for which there are very similar degrees of efficacy and safety but substantial variations in cost.
5. Prashker J, Meenan RF: The total costs of drug therapy for rheumatoid arthritis. Arthritis Rheum 1995, 38:318-325. The authors created a model to estimate the total medication costs of treating patients with rheumatoid arthritis with six second-line agents for a 6-month period. Their model consisted of three components: the cost of monitoring patients taking medications, the cost of the medications themselves, and the cost of working up and treating toxicities that can occur in patients taking medications. It was found that the combination of monitoring and toxicity costs accounted for more than 60% of the total costs of treating patients with these medications.
6. Bergquist SR, Felson DT, Prashker MJ, Freedberg KA: The cost-effectiveness of liver biopsy in rheumatoid arthritis patients treated with methotrexate. Arthritis Rheum 1995, 38:326-333. The authors used a decision analytic approach to assess the cost-effectiveness of liver biopsy in monitoring for the development of cirrhosis in rheumatoid arthritis patients taking the second-line agent methotrexate. Their model showed that biopsy after 5 years of treatment with methotrexate had a cost-effectiveness ratio of over $1.8 million and that biopsy after 10 years had a ratio of over $50,000 per year of life saved. In a series of sensitivity analyses, the authors found that their model was most dependent on the probability of development of cirrhosis and concluded that the use of liver biopsy to monitor for methotrexate-induced cirrhosis in rheumatoid arthritis patients is not cost-effective.
7. Asch DA, Hershey JC: Why some health policies don't make sense at the bedside. Ann Intern Med 1995, 122:846-850. The authors provide a framework for discussing whether clinicians should apply cost-effectiveness analyses when making treatment decisions in the care of individual patients. Their argument is that such analyses aggregate the benefits and burdens of alternative treatments across different individuals, resulting in a blunting of the risk for the overall population. They point out that the assumptions behind the majority of these analyses make sense only if one is interested in the aggregate outcome and not in the particular outcome of an individual patient. The result of such reasoning is that the aggregation will underestimate individual risk and may misrepresent the interests of the patient. They conclude that such studies cannot necessarily provide useful guidelines for decision making at the bedside.
8. Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR, the North Carolina Back Pain Project: The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. N Engl J Med 1995, 333:913-7. The investigators used a prospective observational study to determine whether the outcomes of and charges for care differ among primary care practitioners, chiropractors, and orthopedic surgeons. The times to functional recovery, return to work, and complete recovery from low back pain were similar among patients seen by all groups of practitioners, but there were marked differences in the use of health care services. For example, the mean total estimated outpatient charges were highest for the patients seen by orthopedic surgeons and chiropractors and were lowest for the patients who were seen by HMO and primary care providers.