Costs and disease activity in early rheumatoid arthritis in 1996–2000 and 2006–2011, improved outcome and shift in distribution of costs: a two-year follow-up

Abstract

Objective: To evaluate changes in healthcare utilization, costs, and disease activity from 1996 to 2011 for patients with early rheumatoid arthritis (RA).

Method: Two cohorts of patients with early RA, included in 1996–1998 (T1) and 2006–2009 (T2), were followed regularly. Healthcare utilization, costs, and disease activity were compared between cohorts during 2 years after diagnosis.

Results: Disease activity was significantly improved in T2 vs T1. Drug costs increased in T2 vs T1 (EUR 911 vs EUR 535, respectively; p = 0.017), and costs for RA-related hospitalization decreased. More than 90% in T2 were prescribed disease-modifying anti-rheumatic drugs (DMARDs) at inclusion compared to 50% in T1. At 2 year follow-up, levels were still > 90% in T2, while corresponding values in T1 were just above 70%. Comparing T2 to T1, total direct costs were slightly higher in T2 (EUR 3941 vs EUR 3364, respectively; ns), sick leave decreased (EUR 3511 vs EUR 5672; p = 0.025), while disability pension increased slightly (EUR 4889 vs EUR 4244; ns), but total indirect costs remained unchanged (EUR 8400 vs EUR 9916; ns). Total direct and indirect costs did not differ between the cohorts (EUR 12 342 in T2 vs EUR 13 280 in T1; ns), and loss of productivity still represented the largest component of total costs.

Conclusion: T2 patients were prescribed DMARDs earlier and more aggressively than T1 patients. Stable and better improvements in disease activity, function, and quality of life were achieved in T2 compared to T1. There was a shift within the components in direct costs and indirect costs, but total costs remained essentially unchanged.

Acknowledgements

We thank all patients and co-workers in Eskilstuna, Falun, Jönköping, Kalmar, Lindesberg, Linköping, Motala, Norrköping, Oskarshamn, Västervik, and Örebro. We also thank Ms Ylva Billing for excellent co-operation.

This work was supported by the County Council in Östergötland, Sweden, the Norrbacka-Eugenia Foundation, and the Medical Research County Council of South-East Sweden (FORSS).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Medical Research County Council of South-East Sweden (FORSS);County Council in Östergötland;