Ann Rheum Dis 64:1456-1461 doi:10.1136/ard.2004.031880
  • Extended report

Direct costs related to rheumatoid arthritis: the patient perspective

  1. J L Hülsemann1,*,
  2. T Mittendorf2,
  3. S Merkesdal1,
  4. S Zeh1,
  5. S Handelmann1,
  6. J‐ M von der Schulenburg2,
  7. H Zeidler1,
  8. J Ruof1,*
  1. 1Division of Rheumatology, Hannover Medical School, Hannover, Germany
  2. 2Centre for Health Economics, University of Hannover, Hannover, Germany
  1. Correspondence to:
    Dr J L Hülsemann
    Division of Rheumatology, Hannover Medical School, Hannover, Germany Carl-Neuberg-Str 1, D-30625 Hannover, Germany;
  • Accepted 21 March 2005
  • Published Online First 30 March 2005


Objective: To determine rheumatoid arthritis related out of pocket expenditure (OOPE) in Germany and to disaggregate the total OOPE into contributing cost domains.

Methods: Data for the cost analysis were drawn from a multicentre randomised controlled prospective trial to assess the effectiveness of clinical quality management in patients with rheumatoid arthritis. Both payer sources and patient cost questionnaires were used to generate health care utilisation data. All cost domains of a recently published matrix were reviewed and potential sources of OOPE were determined. Health care utilisation data were developed throughout 2001. Co-payment regulations as per January 2004 were applied in order to indicate the most recent level of OOPE in Germany. Data were analysed in both physical and monetary units using descriptive statistics.

Results: In all, 136 patients with rheumatoid arthritis were included. Mean total OOPE per patient and year was €417.20 (SEM 38.8, median 271.2). OOPE accounted for 15.3% of the total direct costs of rheumatoid arthritis. Total OOPE were further subdivided into cost domains: “non-physician service utilisation”’ (€194.40 per patient and year; SEM 24.2), “medication” (€99.00; 6.1), “transportation” (€56.20; 17.4), “visits to physicians” (€38.40; 0.6), “hospital facilities” (€24.00; 5.6), and “devices and aids” (€5.10; 0.8).

Conclusions: Rheumatoid arthritis is associated with substantial OOPE, imposing a considerable economic burden for patients. OOPE contribute significantly to the total health care expenditure in rheumatoid arthritis. The patient perspective has to be taken into account when calculating the overall direct costs of rheumatoid arthritis from a societal point of view.


  • * JLH and JR contributed equally to this paper

  • Published Online First 30 March 2005