The Costs of Rheumatoid Arthritis

Abstract

The economic costs associated with rheumatoid arthritis (RA), a chronic, systemic, inflammatory disorder that affects many joints, are high, approximating those of coronary heart disease. The estimated prevalence of RA in the US is 0.9%. Incidence increases with age, and is highest among women in the fourth to sixth decades of life. The primary impact of RA is due to the significant morbidity associated with this disease. Mortality is increased among a poorly defined subgroup of RA patients. The average level of disability among RA patients is moderate, but 6.5 to 12% of patients are severely disabled. Between one- and two-thirds of previously employed patients have a reduced work capacity. Treatment primarily involves the use of nonsteroidal anti-inflammatory drugs and disease modifying antirheumatic drugs. Rehabilitation measures and orthopaedic surgery are also used. Total annual direct costs of RA (total charges) have been calculated to be $US5275 and $US6099 (1991 dollars) per patient. Lifetime medical care charges were estimated at $US12,578 per patient (1991 dollars). The direct costs of RA are substantial, but indirect costs have been calculated to be much higher because of extensive morbidity. The difference between the direct and indirect costs of RA is decreasing because salary increases have not kept pace with rising healthcare costs. The latter are increasing rapidly in RA because of the use of new technology, surgical procedures, and the greater use of drugs with frequent monitoring requirements and significant toxicity. Because intangible costs such as pain form a substantial part of the overall costs of RA but are difficult to evaluate, cost estimates inevitably underestimate the impact of the disease on individuals and society.

Economic impact of juvenile idiopathic arthritis

“…In general, a characteristic of current care patterns, in contrast with earlier eras, is that much fewer children with JIA are admitted to the hospital. Also, in the Allaire et al sample (8), there was a higher percentage of subjects with polyarthritis (33.3%) and systemic JIA (18.8%), which may partly explain the higher inpatient costs. Conversely, in the study by Allaire et al (8), medications contributed Ͻ10% of the total direct medical costs, but accounted for 44% of the total direct medical costs in our study.…”

“…Also, in the Allaire et al sample (8), there was a higher percentage of subjects with polyarthritis (33.3%) and systemic JIA (18.8%), which may partly explain the higher inpatient costs. Conversely, in the study by Allaire et al (8), medications contributed Ͻ10% of the total direct medical costs, but accounted for 44% of the total direct medical costs in our study. From a societal perspective, indirect costs (that is, the burden sustained by the patient and/or caregivers) are obviously also very important.…”

“…A large portion of direct costs in inflammatory arthritis is related to use of health services, including visits to physicians (and allied health care professionals) (7). To date, only 1 study has been published estimating the economic cost for children with JIA; this study was performed almost 2 decades ago (8), when therapeutic approaches…”

“…Bernatsky et al performed almost 2 decades ago by Allaire et al (8), and estimated a much higher mean annualized direct health care cost amounting to $5,700 in 1989 US dollars ($10,801 in 2005 Canadian dollars). This finding was in part driven by much higher inpatient care costs in their sample from this earlier era (mean annualized inpatient costs were onethird of the direct medical costs).…”

Guidelines for the management of rheumatoid arthritis: 2002 Update

“…Most patients experience a chronic fluctuating course of disease that, despite therapy, may result in progressive joint destruction, deformity, disability, and even premature death (2). RA results in more than 9 million physician visits and more than 250,000 hospitalizations per year (3,4). Disability from RA causes major economic loss and can have a profound impact on families.…”