Utilization Patterns of Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis: Rationale for Improving the Harmonization of Coverage Criteria
Bibliographic record
Abstract
Utilization patterns of csDMARDs were highly comparable between drug plans overall (in decreasing order: methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, and azathioprine). The proportion of csDMARDs were comparable (e.g., approximately 30% of csDMARD use for methotrexate), although differences in coverage criteria may have resulted in variances in the use of leflunomide. Differences in adjudication of coverage criteria may have resulted in a modest variance in the number of csDMARDs used prior to initiating bDMARDs (i.e., allowing for an “early escape” to bDMARDs for some jurisdictions such as Manitoba and the Atlantic provinces). The mean time to initiate bDMARD therapy (range of 664 to 792 days) revealed a divergence between jurisdictions into 2 groupings whereby Manitoba, Saskatchewan, and the Atlantic provinces drug plans (mean time of 664 to 681 days) saw the initiation of bDMARDs approximately 4 months faster versus other jurisdictions (British Columbia, Alberta, and Ontario, with a mean time of 748 to 792 days), possibly due to their coverage criteria not requiring 3 lines of csDMARDs therapy. Despite differences in the time to initiate bDMARDs, there was no notable difference in the persistence of bDMARDs 6 months after the initiation for any drug plan (61% to 76% range for patients 67 years of age and older). Utilization patterns of bDMARDs was highly comparable between drug plans (i.e., highest use with adalimumab, etanercept, and infliximab), although British Columbia and Manitoba were the only jurisdictions that saw decreasing costs per patient of bDMARDs over time, likely due to a higher uptake of biosimilars or other managed formulary strategies such as tiering.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".