The impact of arthritis and joint pain on individual healthcare expenditures: findings from the Medical Expenditure Panel Survey (MEPS), 2011

Limited Physical Functioning in United States Adults with Arthritis: Findings from the 2021 Medical Expenditure Panel Survey

There is little published research on limited physical functioning in United States (US) adults with arthritis. The objective of this cross-sectional 2021 Medical Expenditure Panel Survey (MEPS) database study was to investigate the variables associated with limited physical functioning in US adults with arthritis. Logistic regression tested the associations of predisposing, enabling, and need variables with the dependent variable (limited physical functioning). This study included 5102 US adults with arthritis, reflecting an estimated weighted population of 64,136,870 US adults with arthritis. In the final multivariable logistic regression model, age ≥ 70 and ages 60-69 (vs. 18-49 years), female (vs. male) sex, having quite a bit/extreme or moderate (vs. little) pain, and having 6+ or 4-5 (vs. 0-1) comorbid conditions were all associated with higher odds of the person stating they had limited physical functioning. Whereas high school or less (vs. more than high school), being employed (vs. unemployed), being married (vs. not married), having excellent/very good or good (vs. poor) general health, and exercise (vs. no exercise) were each associated with lower odds of the person reporting they had limited physical functioning. Future work may be considered to explore these variables in greater detail.

The economic burden of biologic disease-modifying antirheumatic drugs in rheumatoid arthritis patients in the United States

BACKGROUND

Previous U.S. economic burden estimates for rheumatoid arthritis (RA) varied from $85.6 to 148.1 billion annually. However, these estimates do not reflect comparative amounts spent on RA treatment options in addition to other medical expenditures. Therefore, this study's goal was to comparatively analyze the overall economic burden of U.S. patients treated for RA using conventional disease-modifying antirheumatic drugs (DMARDs) versus TNF alpha biologic DMARDs.

RESEARCH DESIGN AND METHODS

This retrospective observational study analyzed Medical Expenditure Panel Survey Household Component data from 2016 to 2018. Healthcare utilization, total medical expenditures, and out-of-pocket expenditures were compared between RA medication groups.

RESULTS

Three hundred twenty-five adult RA patients experiencing 603 RA-related events, including at least one medical visit, between 2016 and 2018 were identified. Rheumatic arthritis-attributable medical expenditures among patients prescribed DMARDs were $11.4 billion. Average total medical expenditures were significantly higher for the TNF alpha biologic group $26,216.67 (95% CI: $19,502.84-$32,930.5) versus $5,388.52 (95% CI: $2,768.25-$8,008.79) for the conventional DMARD group (p<0.001).

CONCLUSIONS

RA patients receiving TNF alpha biologics experienced significantly higher total medical and out-of-pocket expenditures; however, they have experienced fewer or no occurrences of high-cost drivers of healthcare utilization compared to patients receiving conventional DMARDs.

Characteristics Associated with Good Self-Perceived Mental Health among United States Adults with Arthritis

Mental health disorders are prevalent among United States (US) adults with arthritis. Yet, little is known about characteristics associated with mental health among US adults with arthritis. This retrospective cross-sectional study used 2019 Medical Expenditures Panel Survey data to assess the association between multiple personal characteristics and mental health status among US adults with arthritis. Hierarchical logistic regression models modeled associations between personal characteristics and mental health status. Model 1 included predisposing factors, model 2 included predisposing and enabling factors, while model 3 included predisposing, enabling, and need factors. The a priori alpha level was 0.05. Analyses accounted for the complex survey design and were weighted to produce national estimates. Among 28,512 individuals, 4984 met the inclusion criteria. Of these, 4181 had good mental health (85.5%, 95% confidence interval (CI) = 84.3%, 86.7%). The following characteristics were associated with good mental health status in the final adjusted model: age 18–64 vs. ≥65 (adjusted odds ratio (AOR) = 0.29, 95% CI = 0.12, 0.71), Midwest vs. West census region (AOR = 5.17, 95% CI = 1.63, 16.46), no degree vs. higher than high school education (AOR = 0.34, 95% CI = 0.12, 0.92), and high school diploma vs. higher than high school education (AOR = 0.40, 95% CI = 0.18, 0.86). In conclusion, this study suggests such characteristics may be targeted to help improve mental health among this population. Additional efforts are needed to help satisfy the unmet need for mental healthcare among this population.

Trends and Racial/Ethnic Differences in Health Care Spending Stratified by Gender among Adults with Arthritis in the United States 2011-2019

The purpose of this study was to determine if there were racial/ethnic differences and patterns for individual office-based visit expenditures by gender among a nationally representative sample of adults with arthritis. We retrospectively analyzed pooled data from the 2011 to 2019 Medical Expenditure Panel Survey of adults who self-reported an arthritis diagnosis, stratified by gender (men = 13,378; women = 33,261). Our dependent variable was office-based visit expenditures. Our independent variables were survey year (categorized as 2011-2013, 2014-2016, 2017-2019) and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian, non-Hispanic other/multiracial). We conducted trends analysis to assess for changes in expenditures over time. We utilized a two-part model to assess differences in office-based expenditures among participants who had any office-based expenditure and then calculated the average marginal effects. The unadjusted office-based visit expenditures increased significantly across the study period for both men and women with arthritis, as well as for some racial and ethnic groups depending on gender. Differing racial and ethnic patterns of expenditures by gender remained after accounting for socio-demographic, healthcare access, and health status factors. Delaying care was an independent driver of higher office-based expenditures for women with arthritis but not men. Our findings reinforce the escalating burden of healthcare costs among U.S. adults with arthritis across genders and certain racial and ethnic groups.

Comparison of Health Care Expenditures Among U.S. Older Adults With Pain Who Reported Frequent Exercise Versus Nonfrequent Exercise

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate-vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p = .007). There were no statistical differences between frequent exercise status for other health care expenditure types (p > .05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not.

Pain and Fatigue in Patients With Ankylosing Spondylitis Treated With Tumor Necrosis Factor Inhibitors: Multinational Real-World Findings

BACKGROUND/OBJECTIVE

Patients with ankylosing spondylitis (AS) experience symptoms and comorbidities that impact their health-related quality of life (HRQoL) and ability to work. This real-world, global survey was conducted among AS patients receiving tumor necrosis factor inhibitors (TNFis) to evaluate both the frequency and severity of persistent symptoms, and the impact of pain and fatigue on HRQoL, employment status, and work activity.

METHODS

Patients with AS and their treating physicians from 13 countries across 5 continents completed questionnaires capturing demographics, patient symptoms, current disease status, HRQoL, current therapy, employment status, and Work Productivity and Activity Impairment.

RESULTS

Seven hundred five patients who had been receiving a TNFi for 3 months or more and completed both Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) pain and fatigue domains were included in the analysis; of these, 37.6% reported high BASDAI pain scores and 41.3% high BASDAI fatigue scores. Medical Outcomes Study-Short Form, 36-item version 2 domain, 5-dimensional EuroQoL Questionnaire, and 5-dimensional EuroQoL visual analog scale scores were significantly lower (p < 0.0001), and Work Productivity and Activity Impairment scores significantly higher (p < 0.0001), in patients with high levels of pain or fatigue than low levels.

CONCLUSIONS

Globally, levels of pain and fatigue remained high in AS patients receiving TNFi treatment, which were significantly associated with reduced HRQoL and work productivity. Such persistent symptoms in usual care suggest a substantial unmet need in AS pharmacologic and nonpharmacologic therapeutic pathways.

"There are still a lot of things that I need": a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic

Background

Arthritis is a highly prevalent disease and leading cause of disability in the Indigenous population. A novel model of care consisting of a rheumatology outreach clinic in an on-reserve primary healthcare center has provided service to an Indigenous community in Southern Alberta since 2010. Despite quality assessments suggesting this model of care improves accessibility and is effective in meeting treatment targets, substantial improvements in patient-reported outcomes have not been realized. Therefore, the objective of this study was to explore the experiences of Indigenous persons with arthritis and healthcare providers involved in this model of care to inform the development of health service improvements that enhance patient outcomes.

Methods

This was a narrative-based qualitative study involving a purposeful sample of 32 individuals involved in the Indigenous rheumatology model of care. In-depth interviews were conducted to elicit experiences with the existing model of care and to encourage reflections on opportunities to improve it. A two-stage analysis was conducted. The first stage aimed to produce a narrative synthesis of concepts through a dialogical method comparing people with arthritis and health providers’ narratives. The second stage involved a collective effort to synthesize concepts and propose specific recommendations to improve the quality of the current model of care. Triangulation, through participant checking and discussion among researchers, was used to increase the validity of the final recommendations.

Results

Ten Indigenous people with arthritis lived experience, 14 health providers and 8 administrative staff were interviewed. One main overarching theme was identified, which reflected the need to provide services that improve people’s physical and mental functioning. Further, the following specific recommendations were identified: 1) enhancing patient-provider communication, 2) improving the continuity of the healthcare service, 3) increasing community awareness about the presence and negative impact of arthritis, and 4) increasing peer connections and support among people living with arthritis.

Conclusions

Improving the quality of the current Indigenous rheumatology model of care requires implementing strategies that improve functioning, patient-provider communication, continuity of care, community awareness and peer support. A community-based provider who supports people while navigating health services could facilitate the implementation of these strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05909-9.

Level of self-reported pain’s interference with work, and association with number of prescriptions and healthcare expenditures

Objectives

To examine the associations between pain interfering with work and family income and health status and to quantify the impact of pain on pharmaceutical utilization and cost using data from the Medical Expenditure Panel Survey (MEPS).

Methods

The study population included adult respondents to a MEPS pain question asking how much pain interfered with normal work (including both work outside the home and housework) from 2007 to 2014 (n = 71 593 respondents). Generalized linear models estimated the association between pain and family income, self-reported health status, number of prescriptions and healthcare expenditures (prescription drug and total). Control variables included age, gender, education, marital status, poverty, race, immigration status, region, obesity, work status and insurance coverage.

Key findings

Nearly 43% of respondents reported pain did not interfere at all with their work, 32% responded it did ‘a little bit’, 14% said ‘moderately’, 8% reported ‘quite a bit’, and 3% said ‘extremely’. Older respondents were significantly more likely to report pain interfering with work than younger ones. Women were more likely than men to report pain interfering with work. Obesity was significantly associated with pain, with 5.3% of obese respondents stating pain extremely interfered with work compared to 2.2% of nonobese respondents. Those who reported pain interfered ‘extremely’ had, on average, 46 prescriptions filled per year compared to only 5 prescriptions for those reporting less severe pain. This translated into significantly higher prescription drug and total costs.

Conclusion

Innovative targeted interventions are needed to mitigate the severe consequences of pain on health, well-being and cost.

Examining racial and ethnic trends and differences in annual healthcare expenditures among a nationally representative sample of adults with arthritis from 2008 to 2016

BACKGROUND

Disparities in health care utilization and outcomes for racial and ethnic minorities with arthritis are well-established. However, there is a paucity of research on racial and ethnic differences in healthcare expenditures and if this relationship has changed over time. Our objectives were to: 1) examine trends in annual healthcare expenditures for adults with arthritis by race and ethnicity, and 2) determine if racial and ethnic differences in annual healthcare expenditures were independent of other factors such as healthcare access and functional disability.

METHODS

We used the Medical Expenditures Panel Survey (2008-2016) to examine trends in annual healthcare expenditures within and between racial and ethnic groups with arthritis (n = 227,663). A two-part model was used to estimate the marginal differences in expenditures by race and ethnicity after adjusting for relevant covariates, including the impact of healthcare access.

RESULTS

Between 2008 and 2016, there were no significant changes in unadjusted healthcare expenditures within any of the racial and ethnic groups, but the trend among non-Hispanic whites did differ significantly from Hispanics and Other. In fully adjusted analysis, mean annual expenditures for non-Hispanic whites was $946, $939, and $1178 more than non-Hispanic blacks, Hispanics, and Other, respectively (p < .001). Healthcare access also independently explained expenditure differences in this population with adults who delayed care spending significantly more ($2629) versus those who went without care spending significantly less (-$1591).

CONCLUSIONS

Race and ethnicity are independent drivers of healthcare expenditures among adults with arthritis independent of healthcare access and functional disability. This underscores the need for ongoing research on the factors that influence persistent racial and ethnic differences in this population.

Relationship of pain and fatigue with health-related quality of life and work in patients with psoriatic arthritis on TNFi: results of a multi-national real-world study

BACKGROUND/OBJECTIVE

The incidence of pain and/or fatigue in people with psoriatic arthritis (PsA) is associated with reduced health-related quality of life (HRQoL) and the ability to work, despite modern advanced therapeutic approaches. This real-world, international study examined these relationships in patients with PsA treated with tumour necrosis factor inhibitors (TNFi).

METHODS

Data from 13 countries were analysed. Patients with PsA and their physicians completed questionnaires capturing demographics, current therapy, current disease status, HRQoL and work status via Medical Outcomes Study 36-Item Short-Form version 2 (SF-36v2), 3-level 5-dimension EuroQoL questionnaire, Health Assessment Questionnaire Disability Index, and Work Productivity and Activity Impairment (WPAI) questionnaire.

RESULTS

640 patients with PsA were included who had been receiving TNFi for ≥3 months and had completed SF-36v2 bodily pain and vitality domains. Of these, 33.1%, 29.2% and 37.7% of patients reported no, moderate and severe pain, respectively, and 31.9%, 22.5% and 45.6% of patients reported low, moderate and severe fatigue, respectively. Scores across HRQoL variables and WPAI were significantly different across pain and fatigue cohorts (all p<0.0001), with HRQoL and WPAI measures considerably worse in patients with moderate to severe pain or fatigue than those with low pain or fatigue.

CONCLUSIONS

Despite treatment with biologic agents such as TNFi, data from this global study demonstrated that substantial pain and/or fatigue persist in patients with PsA and that these are significantly associated with reduced HRQoL, physical function and work productivity. These findings suggest that there is an unmet need for additional PsA therapies.

A systematic investigation on the research publications that have used the medical expenditure panel survey (MEPS) data through a bibliometrics approach

Purpose

This study aimed to examine how Medical Expenditure Panel Survey (MEPS) data have been used to support scientific discoveries in biomedical and health sciences, and provide insight to researchers who are interested in using MEPS regarding collaborations and dissemination of research output.

Design/methodology/approach

A bibliometric approach was used to systematically examine the publications that used MEPS data and were indexed by PubMed and Web of Science (WoS). Microsoft Excel and bibliometric tools (WoS and VOSviewer) were utilized for quantitative and bibliometric network analysis. The measures were investigated on the total number of publications by year, research categories, source journals, other datasets/databases co-used with MEPS, funding sources, collaboration patterns, and research topics.

Findings

A total of 1,953 eligible publications were included in this study with the numbers growing significantly over time. MEPS data were primarily used in healthcare services, public environmental and occupational health research. The journals that published the most papers using MEPS were all in the healthcare research area. Twenty-four other databases were found to be used along with MEPS. Over 3,200 researchers from 1,074 institutions in 25 countries have contributed to the publications. Research funding was supported from federal, private, local, and international agencies. Three clusters of research topics were identified among 235 key terms extracted from titles and abstracts.

Originality/value

Our results illustrated the broad landscape of the research efforts that MEPS data have supported and substantiated the value of AHRQ's effort of providing MEPS to the public.

Stem Cells and Platelet-rich Plasma for Knee Osteoarthritis: Prevalence and Cost in South Florida

INTRODUCTION

The use of stem cell therapy (SCT) and platelet-rich plasma (PRP) injection for knee osteoarthritis (OA) is extremely controversial and at best experimental stage. These treatments are being offered across the nation for "cash-only payments." Our objectives were to determine (1) what proportion of board-certified orthopedic surgeons in Miami-Dade County offer SCT or PRP and (2) how much do practices charge for these services.

METHODS

All board-certified orthopedic surgeons' offices in Miami-Dade County were identified by their American Academy of Orthopaedic Surgeons active membership. Offices were contacted and presented a hypothetical patient with end-stage OA searching for treatment (SCT or PRP injections) before having to undergo surgery.

RESULTS

Of the 96 registered American Academy of Orthopaedic Surgeons member's offices, 91 (94.7%) were contacted, 36% of offices offered PRP, and 24.5% offered SCT. However, 81% of the offices were transparent on the pricing of PRP, whereas 42% gave a price for SCT. Remaining practices stated that pricing would be "determined or discussed" during a scheduled visit. Mean cost for PRP injection was $897 (range, $350 to $1,700), and for SCT injection, it was $3,100 (range, $1,200 to $6,000).

DISCUSSION

Biological injectables as treatment of knee OA have potential use in the nonsurgical management of this disease. Data on the effectiveness are lacking and are conflicting. Data should continue to be investigational.

LEVEL OF EVIDENCE

Level IV.

Budget impact model of secukinumab for the treatment of moderate-to-severe psoriasis, psoriatic arthritis, and ankylosing spondylitis in Italy: a cross-indication initiative

Objective

Secukinumab, a fully human monoclonal IgG1 antibody that selectively neutralizes the proinflammatory cytokine IL-17A, has been approved in Europe in 2015 for the treatment of adult patients with moderate-to-severe plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). This analysis assessed the budget impact of introduction of secukinumab to the Italian market for all three indications from the perspective of the Italian National Health Service.

Materials and methods

A cross-indication budget impact model was developed and included biologic-treated adult patients diagnosed with psoriasis, PsA, and AS. The analyses were conducted over a 3-year time horizon and included direct costs (drug therapy costs, administration costs, diseases-related costs, and adverse events costs). Model input parameters (epidemiology, market share projections, resource use, and costs) were obtained from the published literature and other Italian sources. The robustness of the results was tested via one-way sensitivity analyses: secukinumab cost, secukinumab market share, intravenous administration costs, and adverse events costs were varied by ±10%.

Results

The total patient population for secukinumab over the 3-year timeframe was projected to be 6,648 in the first year, increasing to 12,001 in the third year, for all three indications combined (psoriasis, PsA, and AS). Compared to a scenario without secukinumab in the market, the introduction of secukinumab in the market for the treatment of psoriasis, PsA, and AS showed a cumulative 3-year incremental budget impact of −5%, corresponding to savings of €66.1 million and per patient savings of about €1,855. The majority of the cost savings came from the adoption of secukinumab in AS (58%), followed by PsA (29%) and psoriasis (13%). Sensitivity analyses confirmed the robustness of the results.

Conclusion

Results from this cross-indication budget impact model show that secukinumab is a cost-saving option for the treatment of PsA, AS, and psoriasis patients in Italy.

Secukinumab provides rapid and sustained pain relief in psoriatic arthritis over 2 years: results from the FUTURE 2 study

Background

Pain is one of the most important domains affecting health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA). Secukinumab has demonstrated rapid and sustained improvements in signs and symptoms, including HRQoL, among patients with active PsA. This analysis evaluates the effect of secukinumab on patient-reported pain in PsA through 104 weeks of treatment.

Methods

Pain was assessed through week 104 using clinically relevant measures, including change from baseline in a pain visual analog scale (VAS) and Short Form-36 (SF-36) bodily domain scores; proportion of patients reporting improvements equal to or better than minimum clinically meaningful differences in the pain VAS and SF-36 bodily pain domain scores; and proportion of patients with no, moderate, or extreme pain/discomfort measured by the EuroQoL 5-Dimension 3-Level Questionnaire (EQ-5D-3 L) pain item scores. Correlations of pain measures were analyzed using Pearson’s correlation coefficient. Pre-specified analyses of TNF-naïve patients and patients who stopped TNF-inhibitors (TNFis) due to inadequate responses or safety/tolerability (TNF-IR patients) were performed using “as-observed data.”

Results

Mean improvements from baseline in pain VAS scores were greater with secukinumab versus placebo by week 3 (− 16.9; P < 0.0001 with secukinumab 300 mg and − 12.6; P < 0.05 with secukinumab 150 mg) and sustained through week 104. SF-36 bodily pain domain scores were significantly greater with 300 mg secukinumab and secukinumab 150 mg versus placebo by week 4 (16.2 and 16.3, respectively; P < 0.0001 for both), and these changes were maintained through week 104. With both secukinumab 300 mg and secukinumab 150 mg, improvements equal to or better than the minimum clinically meaningful differences in pain VAS and SF-36 bodily pain were significant versus placebo at week 3 and week 4, respectively. At week 4, 15%, 9%, and 5% of patients receiving secukinumab 300 mg, secukinumab 150 mg, and placebo, respectively, reported “no pain/discomfort” measured by EQ-5D-3 L; these proportions increased to week 104 with both secukinumab doses. Similarly, improvements in pain measures were significant in both TNF-naïve and TNF-IR patients.

Conclusion

Secukinumab provided rapid and sustained pain relief in PsA over 2 years of treatment. Improvements in pain were reported regardless of prior exposure to TNFis.

Trial registration

ClinicalTrials.gov, NCT01752634. Registered on 19 December 2012.

Electronic supplementary material

The online version of this article (10.1186/s13075-018-1610-3) contains supplementary material, which is available to authorized users.

Variation in perceived providers of ambulatory physical therapy in the United States, 2009-2012: An analysis using data from the Medical Expenditure Panel Survey

Introduction: Little is known about public perception of physical therapy (PT) delivery by type of provider in the United States (US). Purpose: This study aimed to describe differences in ambulatory PT visits and expenditures according to perceived provider type, and to determine if visits and expenditures varied by provider type. Methods: This study employed the Medical Expenditure Panel Survey (MEPS), which is a nationally representative survey of US households that used a complex, stratified, cluster sample design. Data from cross-sectional samples over 4 years of the MEPS Household Component were used to study adults with musculoskeletal conditions who reported receiving ambulatory PT. National-level, average annual estimates of numbers of visits, and reported total expenditures by perceived provider type were computed. Associations between perceived provider type and visits and expenditures were determined by linear regression, accounting for the sample design, and adjusting for demographic and clinical covariates. Results: Estimated annual perceived PT visits were 60.00 million with physical therapists, 39.66 million with non-physical therapist providers, and 20.66 million with multiple providers. Estimated annual expenditures for PT were $9.37 billion with physical therapists, $4.62 billion with non-physical therapist providers, and $3.09 billion with multiple providers. Compared with non-physical therapist providers, physical therapist provider status and multiple provider status were associated with higher numbers of visits and expenditures. Conclusion: Non-physical therapist providers are responsible for a substantial amount of PT delivery in the US. Numbers of visits and total expenditures varied by the type of provider delivering PT.

Evaluation of Self-reported Patient Experiences: Insights from Digital Patient Communities in Psoriatic Arthritis

Objective.

To evaluate the types of experiences and treatment access challenges of patients with psoriatic arthritis (PsA) using self-reported online narratives.

Methods.

English-language patient narratives reported between January 2010 and May 2016 were collected from 31 online sources (general health social networking sites, disease-focused patient forums, treatment reviews, general health forums, mainstream social media sites) for analysis of functional impairment and 40 online sources for assessment of barriers to treatment. Using natural language processing and manual curation, patient-reported experiences were categorized into 6 high-level concepts of functional impairment [social, physical, emotional, cognitive, role activity (SPEC-R), and general] and 6 categories to determine barriers to treatment access (coverage ineligibility, out-of-pocket cost, issues with assistance programs, clinical ineligibility, formulary placement/sequence, doctor guidance). The SPEC-R categorization was also applied to 3 validated PsA patient-reported outcome (PRO) instruments to evaluate their capacity to collect lower-level subconcepts extracted from patient narratives.

Results.

Of 15,390 narratives collected from 3139 patients with PsA for exploratory analysis, physical concepts were the most common (81.5%), followed by emotional (50.7%), cognitive (20.0%), role activity (8.1%), and social (5.6%) concepts. Cognitive impairments and disease burden on family and parenting were not recorded by PsA PRO instruments. The most commonly cited barriers to treatment were coverage ineligibility (51.6%) and high out-of-pocket expenses (31.7%).

Conclusion.

Patients often discussed physical and emotional implications of PsA in online platforms; some commonly used PRO instruments in PsA may not identify cognitive issues or parenting/family burden. Nearly one-third of patients with PsA reported access barriers to treatment.

Trends in Healthcare Expenditures among Individuals with Arthritis in the United States from 2008 to 2014

OBJECTIVE

With the expected rise in the arthritis population, information is required regarding trends of healthcare expenditures among individuals with arthritis in the United States. We examined temporal trends in direct and out-of-pocket (OOP) healthcare expenditures among individuals with arthritis using a nationally representative database, the Medical Expenditures Panel Survey.

METHODS

The study population was composed of cross-sectional cohorts of individuals aged ≥ 18 years from 2008 to 2014. Two-part models were used to estimate the incremental total and types of annual direct and OOP healthcare expenditures (adjusted to 2014 US dollars) for arthritis, after controlling for predisposing, enabling, need, personal health practice, and external environmental factors, as per the Anderson Healthcare Behavioral Model.

RESULTS

An annual weighted arthritis population rose from 56.1 million in 2008 to 65.1 million in 2014. Among individuals with arthritis, the annual average direct and OOP expenditure was $10,424 [standard error (SE) = $345, aggregate = $584.8 billion] and $1493 (SE = $50, aggregate = $83.8 billion) in 2008, respectively, and $910 (SE = $279, total = $645.1 billion) and $1099 (SE = $36, aggregate = $71.5 billion) in 2014, respectively. In the fully adjusted model, individuals with arthritis had significantly greater total and OOP expenditures from 2008 to 2014; however, the magnitude of incremental OOP expenditure declined from 2008 to 2014.

CONCLUSION

Although the annual direct healthcare expenditures per person remained stable over the years, the rise in proportion of the arthritis population led to a huge increase in aggregate economic burden to the US healthcare system.