Direct medical costs and their predictors in patients with rheumatoid arthritis

Abstract

Objective. To estimate total direct medical costs in persons with rheumatoid arthritis (RA) and to characterize predictors of these costs.Methods. Patients (n ‫؍‬ 7,527) participating in a longitudinal study of outcome in RA completed 25,050 semiannual questionnaires from January 1999 through December 2001. From these we determined direct medical care costs converted to 2001 US dollars using the consumer price index. We used generalized estimating equations to examine potential predictors of the costs. Monte Carlo simulations and sensitivity analyses were performed to evaluate the varying prevalence and cost of biologic therapy.Results. The mean total annual direct medical care cost in 2001 for a patient with RA was $9,519. Drug costs were $6,324 (66% of the total), while hospitalization costs were only $1,573 (17%). Approximately 25% of patients received biologic therapy. The mean total annual direct cost for patients receiving biologic agents was $19,016 per year, while the cost for those not receiving biologic therapy was $6,164. RA patients who were in the worst quartile of functional status, as measured by the Health Assessment Questionnaire, experienced direct medical costs for the subsequent year that were $5,022 more than the costs incurred by those in the best quartile. Physical status as determined by the Short Form 36 physical component scale had a similar large effect on RA costs, as did comorbidity. Medical insurance type played a more limited role. However, those without insurance had substantially lower service utilization and costs, and health maintenance organization patients had lower drug costs and total medical costs. Increased years of education, increased income, and majority ethnic status were all associated with increased drug costs but not hospitalization costs. Costs in all categories decreased after age 65 years.Conclusion. Estimates of direct medical costs for patients with RA are substantially higher than cost estimates before the biologic therapy era, and costs are now driven predominantly by the cost of drugs, primarily biologic agents. RA patients with poor function continue to incur substantially higher costs, as do those with comorbid conditions, and sociodemographic characteristics also play an important role in determination of costs.

Pain exacerbation as a major source of lost productive time in US workers with arthritis

“…Arthritis affects 15% of US adults (1) and is associated with increased disability (2-4), direct medical care costs (3,(5)(6)(7)(8)(9), underemployment (10), earnings losses (5,6), and lost productive work time (LPT) (11). Arthritis occurs at all ages, increases in prevalence with age, and is common in working adults, especially those 35-64 years of age (1).…”

Estudo de custo-análise do tratamento da artrite reumatoide grave em um município do Sul do Brasil

“…Nos Estados Unidos, na Colôm-bia e na Argentina 28,29,30,31 , o maior responsável pelos custos diretos médicos relacionados à doença foi a aquisição de medicamentos, tal como observado no presente estudo. Na Alemanha, as consultas com profissionais da saúde foram os principais componentes 32 , em contrapartida, na França, as hospitalizações foram consideradas os principais contribuintes 33 .…”

Correction: Scale Characteristics and Mapping Accuracy of the US EQ-5D, UK EQ-5D, and SF-6D in Patients with Rheumatoid Arthritis

“…Total joint replacement (Yes or No) measures the influence of chronic RA severity and activity, as joint replacement is the end product of RA activity. Total direct medical costs, adjusted to 2007, were calculated from hospitalization, treatment, and utilization data as described 27 . Comorbidity: We used self-reported comorbidities to compute a composite comorbidity index (range 0-9) comprising 11 present or past comorbid conditions including pulmonary disorders, myocardial infarction, other cardiovascular disorders, stroke, hypertension, diabetes, spine/hip/leg fracture, depression, GI ulcer, other GI disorders, and cancer 24,25,28 .…”