Trends in Total Elbow Arthroplasty in Patients with Rheumatoid Arthritis Receiving Disease-Modifying Antirheumatic Drug Therapy based on Payer Status.

Abstract

Total elbow arthroplasty (TEA) is often utilized to manage advanced arthropathies of the elbow secondary to inflammatory conditions such as rheumatoid arthritis (RA). Recent literature has shown that utilization of TEA is decreasing in patients with RA, part of which can be attributed to early medical management involving disease-modifying antirheumatic drugs (DMARDs). However, there is a significant economic barrier to accessing DMARD therapy. The purpose of this study was to compare the utilization of TEA between patients with and without DMARD therapy from 2010-2020. A retrospective cohort analysis was performed using a national insurance claim database to investigate the trends of patients with RA undergoing TEA from 2010-2020. Patients who underwent TEA and had a diagnosis of RA were identified using Current Procedural Terminology (CPT) and International Classification of Disease (ICD) 9 and ICD-10 codes between 2010- 2020. These patients were then stratified into two cohorts: those with DMARDs prescription claims and those without. A linear regression, CAGR analysis, and chi-square analysis were conducted to compare trends and demographic variables, including insurance type, between cohorts. Additionally, a multivariable logistic regression was subsequently performed to observe odds ratios (OR) and 95% confidence intervals (%). From 2010-2020 there has been no significant change in the incidence of TEA in RA patients without DMARD prescriptions, while there has been a statistically significant decreasing rate of TEA observed in RA patients with DMARD prescription claims. The analysis showed there was a CAGR of - 4%. For patients with a diagnosis of RA and DMARDs prescription claims, the highest incidence of undergoing TEA was seen in the age group of 60-69 while patients with a diagnosis of RA and no DMARDs prescription claims, had the highest incidence of undergoing TEA in the age group of 70-79. The incidence of patients undergoing TEA with a diagnosis of RA and DMARD prescription claims has shown a statistically significant decrease from 2010 to 2020, while no significant difference was observed for patients without DMARD prescription claims. There were no statistically significant differences in the insurance plans between cohorts.