Costs in rheumatology: results and lessons learned from the ‘Hannover Costing Study’

Abstract

The objective of this study is to review the concept of the 'Hannover Costing Study' and to present and discuss the major insights generated during the course of the project. The costing study was performed in conjunction with a randomized controlled prospective trial assessing the effectiveness of a disease management module in rheumatoid arthritis (RA). A full set of clinical and cost data both from patient-reported and payer-derived cost data was developed. In particular the study included (1) the development of a matrix of cost domains which might be used as a common taxonomy in costing studies, (2) the descriptive analysis of payer derived cost data, (3) the analysis of cost data in patients with uncertain diagnosis; (4) the development and validation of a patient-reported costing instrument, and (5) an assessment of productivity costs. The following are the results (1) the developed matrix of cost domains included 16 separate cost domains: 7 outpatient, 3 inpatient, 4 other disease related, and 2 productivity domains; (2) the micro-costing analysis showed total direct costs of <euro> 3,815 per patient-year (standard error of mean, SEM: <euro>267) and RA-related direct costs were <euro>2,312 per patient-year; (3) in patients with uncertain diagnosis of RA and no treatment with 'Disease Modifying Antirheumatic Drugs' (DMARD) costs were significantly lower; (4) the comparison of patient-reported with payer-reported cost data generally supports the use of highly aggregated items to assess health care utilization in RA; (5) productivity costs in patients that are gainfully employed and in patients who receive RA-related retirement payments exceed RA-related direct costs. Furthermore, RA-patients reported their productivity losses adequately. The study added some additional insights to the following questions: What costs should be collected, what level of detail is required for that task, what patients should by analyzed, and what data sources should be used in further studies in RA.

The burden of rheumatoid arthritis and access to treatment: health burden and costs

“…However, the cost curve appears to have a J-shape, with costs in the first year after diagnosis higher than in the following 3-5 years [36,37]. Several studies also found a relation between disease activity and costs [23,30,35,[38][39][40], although the amplitude of the variation is small. One study estimated that direct costs increase from around 600€ per year for patients with low disease activity to 1,200€ for patients with high disease activity [40].…”

“…Several studies also found a relation between disease activity and costs [23,30,35,[38][39][40], although the amplitude of the variation is small. One study estimated that direct costs increase from around 600€ per year for patients with low disease activity to 1,200€ for patients with high disease activity [40]. In contrast, total costs increase from around 5,000€ for patients with minimal functional disability (HAQ B0.5) to 20,000€ for patients with severe disease (HAQ [2) [24,41].…”

Indirect costs in patients with coronary artery disease and mental disorders: A systematic review and meta-analysis

“…The human capital method measures indirect costs as the loss in productivity due to sickness of the employee. The friction cost method estimates the amount of production lost, as long as the referred to the loss of working hours due to absence from the workplace, delayed return to work and impaired productivity [4,16,17]. The present review focuses on indirect costs in CAD patients with comorbid mental disorders compared to CAD patients without mental comorbidity.…”

Thoughts on health economics in rheumatoid arthritis

“…However, function remained the driver of all other cost types (excluding the cost for anti-TNF drugs). This can be further illustrated with a study in Germany that correlated costs with disease activity 17. Costs increased from around €600 for patients with low-disease activity to around €1200 for patients with high-disease activity.…”