THE ECONOMIC BURDEN OF RHEUMATOID ARTHRITIS: BEYOND HEALTH CARE COSTS

Purpose:

From a societal perspective, the cost of treating people with rheumatoid arthritis (RA) must include, in addition to the direct health care costs which are typically covered by health insurance, the out-of-pocket expenditures borne by patients and their caregivers, and productivity losses due to absenteeism, presenteeism and unpaid work loss. The objective of this study is to provide a comprehensive cost estimate for treating RA in British Columbia (BC), Canada.

Method:

Individuals with RA from a population-based cohort in BC identified using physician billings were invited to participate in a survey about their RA care in 2005. An annual questionnaire based survey was mailed to patients that collected information on demographics, disease characteristics, quality of life, health service utilization, caregiver burden, and productivity losses. The patient self-report data were also linked to BC health administrative data on hospitalizations, physician visits, investigations and medications dispensed.

Result:

A total of 395 participants with a RA diagnosis according to BC administrative data completed the survey in 2005 (average age = 64; 67% female). Average RA diagnosis duration was 16.4 years (symptom duration = 19.2 years). The mean Health Assessment Questionnaire (HAQ) score was 1.1, representing mild to moderate physical disability. Only 26% of patients were employed with total annual costs equalling $13,816. Paid work productivity losses, including absenteeism, presenteeism, and reduced work hours, accounted for 35% of total costs (Table). Total costs for the patients who were not working were $17,363. About 32% of them were not working or retired because of RA and the paid work productivity loss due to work stoppage accounted for 32% of total costs.

Conclusion:

The additional costs, beyond the direct health care costs, accounted for a large proportion of the total. From a societal perspective, these costs need to be included to more accurately estimate the disease burden. To more accurately model the cost-effectiveness of RA interventions, future work will focus on developing algorithms to map HAQ scores to costs inclusive of all the cost components noted above.