What Drives Healthcare Costs in Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is associated with high healthcare resource utilization. Research presented at the 2017 annual meeting of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP) aimed to identify what factors drive and determine healthcare costs in that patient population.

Nina Mars, of the Institute for Molecular Medicine Finland, University of Helsinki in Finland, and co-authors accessed clinical and administrative data on patients treated on the rheumatology unit at Jyvaskyla Central Hospital in Finland. They included all primary and specialty healthcare visits from fiscal year 2014, excluding 46 outliers (defined as patients with annual costs exceeding the geometric mean by two standard deviations).

For each patient, the researchers considered three clinical variables: Disease Activity Score, Health Assessment Questionnaire Disability Index, and pain rated on a visual analog scale (0-100). The researchers adjusted for patients with non-zero costs and for age, disease duration, and sex. They then analyzed three age groups separately: patients aged 18-50 years (n = 179), 51-70 years (n = 477), and 71-100 years (n = 300). The groups’ mean per-patient annual healthcare costs were 2,942 euros, 2,914 euros, and 4,026 euros, respectively.

The main factor associated with healthcare costs across all age groups was disease activity. Specifically, an individual’s higher long-term median Disease Activity Score led to an increase in annual costs of 848–1,063 euros. The researchers also found strong evidence of an association between pain and costs in the group aged 18-50 years (every one-point increase on the visual analog scale represented a 31-euro increase in cost, p = 0.002). Evidence also pointed to an association between cost and number of comorbidities in patients aged 51-70 years (a 317-euro increase per additional comorbidity, p < 0.001).