Abstract

Rheumatoid Arthritis (RA), a chronic progressive systemic inflammatory disorder, can exert a tremendous toll from affected persons in terms of impaired functional status, and accelerated morbidity and mortality. The uncontrolled inflammation of RA is associated with substantial economic costs, not only for patients and their families, but also to society. The costs can be broadly divided into: 1) direct costs (including costs for medications, hospitalizations, physician/clinic visits, laboratory and other tests for monitoring therapy, and the costs of diagnosing and treating adverse effects) and 2) indirect costs (including opportunity costs, such as lost wages and impaired productivity at work and at home; failure costs, such as the direct and indirect costs for alternative treatments; and intangible costs, to the patient and family). In recent years, the introduction of novel therapies, particularly biologic agents, as well as newer treatment paradigms, have allowed clinicians to more optimally treat their RA patients. RA patients are more likely to achieve lower disease activity and better outcomes, such as improved functional status. Such improvements decrease the indirect costs of RA, and hence may balance costs related to treatment. Due to increasing health care costs worldwide, there has been interest in assessing the value of medical therapies. In RA, a large number of pharmacoeconomic assessments have been performed, including assessments of data from randomized clinical trials. There are both advantages as well as limitations to using data from clinical trials for pharmacoeconomic assessments. Overall, data from clinical trials provide support for the conclusion that in patients with severe active RA, highly effective interventions, including the use of biologic agents, can have an incremental cost efficacy within the accepted range for medical interventions.