Rheumatoid Arthritis Carries Comprehensive Burden

Rheumatoid arthritis (RA) is responsible for premature mortality, disability, reduced quality of life, and higher health care costs in the United States. According to the Medical Expenditure Panel Survey, arthritis and other rheumatic conditions cost the US $80.8 billion in medical care expenditures and $47 billion in lost earnings (total: $127.8 billion) in 2003.¹

Rheumatoid arthritis was principally responsible for a total of 15,600 hospitalizations, resulting in total hospital charges of $545 million in 2009. This represents a decrease from 19,900 hospitalizations in 2004.² Women and persons aged 45+ years accounted for most of these stays.²

The 2007 National Ambulatory Medical Care and National Hospital Ambulatory Medical Surveys report that a total of 2.9 million ambulatory care visits for RA took place in the US in 2007.² Most of these (2.6 million) were physician office visits, and the remaining 1.9 million visits were to medical specialists such as rheumatologists.² This is a decrease from 1997, when 4 million visits (3.6 million physician office visits) were documented.²

Direct medical costs among patients with RA in the Rochester Epidemiology Project averaged $3802 per person during 1987. Furthermore, people with RA were approximately 6 times more likely to incur medical charges compared with those without RA.²

Rheumatoid arthritis also has a negative impact on employment. One study found that people with RA were more likely to change occupations, reduce work hours, lose their job, retire early, or be unable to find employment compared with people without RA.²

Annual excess health care costs for patients with RA were $8.4 billion, and costs of other RA consequences were $10.9 billion, resulting in a total annual cost of $19.3 billion.³ One-third of the total cost was allocated to employers, 28% to patients, 20% to the government, and 19% to caregivers. Intangible costs (quality-of-life deterioration) were $10.3 billion, and premature mortality was $9.6 billion, resulting in a total annual societal RA cost of $39.2 billion. The authors of the database study noted that this is one of the first studies.³

Morbidity related to RA is a significant cause of health care expenditures as well as reduced quality of life and functional ability. For example, stress fractures are common in patients with RA and can lead to excess health care costs as well as to expenses related to job loss. Inflammatory diseases such as RA influence the bone remodeling process and increase fracture risk. Studies have reported an increased risk of bone loss and fracture in patients with RA. Although bone loss associated with RA can directly lead to fractures, research has found that patients with RA are also at an increased risk to developing osteoporosis.⁴

Osteoarthritis (OA) is a major debilitating disease that affects approximately 27 million persons in the US. Osteoarthritis causes significant morbidity and excess health care costs, as evidenced by a study published in 2009, which quantified the relationship between OA and annual health care expenditures to patients and insurers.⁵

According to data from the MEPS for 1996 through 2005, OA contributed substantially to health care expenditures. Out-of-pocket expenditures were increased by $1379 per year (in 2007 dollars) among women, and insurer expenditures were increased by $4833.

Among men, OA increased out-of-pocket expenditures by $694 annually and insurer expenditures by $4036. Aggregate annual medical care expenditures were increased by $185.5 billion; of that amount, insurer expenditures were $149.4 billion and out-of-pocket expenditures were $36.1 billion.

The health care cost burden associated with OA is large for all groups and, because of the increased prevalence of OA in women, is disproportionately higher for women.⁵

“Understanding the economic costs of OA is important for payers, providers, patients, and other stakeholders. Our study clearly reflects the significant impact of OA on US health care spending,” study author John Rizzo, of Stony Brook University in New York, said in a news release.

“Our results suggest that patients with OA may benefit from greater efforts to promote exercise, proper medication use, and appropriate surgical treatments for the disease,” Rizzo concluded.

References:

1. CDC. Arthritis statistics. http://www.cdc.gov/arthritis/data_ statistics/faqs/cost_analysis.htm. Accessed March 21, 2014.

2. CDC. Arthritis basics. http://www.cdc.gov/arthritis/basics/ rheumatoid.htm#12. Accessed March 21, 2014.

3. Birnbaum H, Pike C, Kaufman R, Marynchenko M, Kidolezi Y, Cifaldi M. Societal cost of rheumatoid arthritis patients in the US. Curr Med Res Opin. 2010;26(1):77-90.

4. NIAMS. http://www.niams.nih.gov/Health_Info/Bone/ Osteoporosis/Conditions_Behaviors/osteoporosis_ra.asp. Accessed March 21, 2014.

5. Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum. 2009;60(12):3546-3553.