Study Reveals Higher Economic, Quality of Life Burden With Rheumatoid Arthritis

Yinan Huang, MS, PhD

Credit: University of Mississippi

Data from a new study elucidate the burden of rheumatoid arthritis (RA), revealing higher health care costs and suboptimal quality in life in adults in the United States with RA.¹

“This is the largest study evaluating the expenditure and quality of life for patients with RA compared to all other populations, providing insights into the economic and humanistic burden among RA patients,” first author Yinan Huang, MS, PhD, Assistant Professor, Pharmacy Administration, and Research Assistant Professor, Research Institute of Pharmaceutical Sciences, University of Mississippi, and coauthors wrote in their paper published in ACR Open Rheumatology.¹

Huang and colleagues analyzed data from the Medical Expenditure Panel Survey from 2018 to 2020 and found a total of 1,296 unweighted patients diagnosed with RA, which represented an annual weighted estimate of 4.27 million patients with RA nationally (95% CI, 3.84-4.69). They also identified a comparative group including 63,378 unweighted individuals without RA, representing an annual weighted estimate of 249,835,278 (95% CI 237,052,031–262,618,524) patients.¹

The study looked at healthcare expenditures including inpatient care, outpatient care, emergency department, office visits, prescription medications, home health, and others. Health-related quality of life (HRQoL) was measured via Short Form 12 Health Survey physical component summary (PCS), mental component summary (MCS), activities of daily living (ADL), and instrumental ADL (IADL). The investigators used 2-part models, multivariable linear regression, and multivariable logistic regression models to analyze the expected cost increases in the RA group, the differences in HRQoL measures, and the association between HRQoL and RA status, respectively.

Huang and colleagues found that the RA group had significantly higher total annual healthcare expenditures than the non-RA group. After adjusting for covariates, the RA group had a total healthcare expenditure of $3,382.97 (95% CI [1,816.50–4,949.44]; P < .0001) higher than that for non-RA. Specifically, the RA group had an average expenditures of prescription medication of $2,319.15 (95% CI [1,408.39–3,229.90]; P < .001) higher than that for the non-RA group. Investigators found no significant differences in other types of health care expenditures between groups in the study.¹

Looking at HRQoL measures, the RA group was associated with lower PCS scores than the non-RA group, with an adjusted marginal difference (AMD) of 4.78 (95% CI, 3.47–6.09) and lower MCS scores (AMD, −0.84 [95% CI, −2.18 to 0.50]). The RA group was also found to be more likely to seek help for ADL (adjusted odds ratio [aOR], 2.02 [95% CI, 1.59–2.56]) and IADL (aOR, 2.11 [95% CI, 1.57–2.84]) compared to the non-RA group.¹

Huang and colleagues noted that their findings differed from previous studies which did not find as high an economic burden in patients with RA, but this discrepancy may be explained by more frequent administration of expensive biologics or new JAK inhibitors in recent years, the increasing cost of biologics in general, and study population differences. However, previous findings on the HRQoL burden of RA were corroborated in this new study.

“Our findings have implications for health policy and clinical practice, particularly regarding the prioritization of healthcare resources for RA management. First, for clinicians, the data on HRQoL in patients with RA offer unique patient perspectives about the impact of the disease of RA and allow clinicians to detect unfavorable disease progression. In addition, in clinical practice, it may be beneficial to assess humanistic outcomes, such as HRQoL and functional limitations, to inform treatment strategies for RA,” Huang and colleagues concluded.¹

A study with similar findings was also published in ACR Open Rheumatology in July and found that 36.3% of 488 surveyed patients with RA had anxiety, depression, and fibromyalgia, although the effect was more pronounced in patients with osetoarthritis.²

The analysis used a multidimensional Health Assessment Questionnaire and looked at associations with Routine Assessment of Patient Index Data 3 scores via adjusted Mantel-Haenszel analyses.²

“...knowledge of patient status (eg, persistent pain in OA and untreated inflammatory activity in RA) appears clinically more informative of the risk of comorbidities than the underlying diagnosis,” Juan Schumukler, MD, from Rush University Medical Center in Chicago, and investigators wrote.²

REFERENCES

1. Huang Y, Li J, Agarwal SK. Economic and Humanistic Burden of Rheumatoid Arthritis: Results From the US National Survey Data 2018–2020. ACR Open Rheumatol. Published online August, 2024. doi: 10.1002/acr2.11728
2. Schmukler J, Malfait AM, Block JA, Pincus T. 36-40% of Routine Care Patients With Osteoarthritis or Rheumatoid Arthritis Screen Positive for Anxiety, Depression, and/or Fibromyalgia on a Single MDHAQ. ACR Open Rheumatol. Published online July 16, 2024. doi:10.1002/acr2.11711