Background Rheumatoid arthritis (RA) represents huge economic problem. International pharmacoeconic studies suggest DAS28 as important predictor of direct medical and productivity costs. We performed a cost-analysis according to DAS28.
These cost analyses are essential for further pharmacoeconomic studies, cost-effectiveness and cost-utility studies to determine comparative/relative effectiveness of particular health intervention.
Objectives To analyze direct and productivity costs for patients with rheumatoid arthritis according to DAS28 parameter values.
Methods This was a retrospective cross-sectional study. We included 116 patients with RA, aged 18-84. The patients were divided in four categories; DAS28 0-2.6, 2.6 - 3.2, 3.2 - 5.1, 5.1 $→ $.
Costs were transferred to US dollars, exchange rate, 1USD =19.11 CZK.
Direct costs were based on the records of all resources for particular patient for the last 12 months.
The costs associated with productivity loss were calculated using Friction cost approach (FCA). We used friction period of 130 workdays. Gross salary in the Czech Republic for 2010 was used as denominator.
Results Mean patients’ age was 57.3 years, mean time from diagnosis was 17.5 years, mean DAS28 and HAQ scores were 3.62 and 1.4, respectively, percentage of women was 84.5% for the whole cohort of patients. Biologic therapy was consumed by 31% of patients.
Total mean direct medical cost per patient/year in each DAS28 category (0-2.6, 2.6 - 3.2, 3.2 - 5.1, 5.1 →) were $7 675.5, $7 512.8, $7 115.2, $8 641.7, respectively. The highest driver for height of medical costs were biologic therapy that represented 65.9%, 71.2%, 61.9% and 46.9%, respectively for each of the DAS28 category.
The highest mean medical costs per patient/year were incurred by patients with high disease activity, however costs of biologics represented the lowest amount compare to other DAS28 categories. However, for these patients there were other strong drivers for height of medical costs which were RA-associated hospital stays and surgery – 34.2% of total medical costs in this DAS28 category.
Total costs (direct medical and productivity) per patient/year in each DAS28 category (0-2.6, 2.6 - 3.2, 3.2 - 5.1, 5.1 →) were $9 187.7, $10 031.7, $8 809.4, $11 076.7, respectively.
Conclusions Annual total mean costs per patient at our cohort were $9 413.1, productivity costs represented about 19.6%. In spite of the fact that there were just 31% of patients on biologic therapy, this treatment incurred up to 71.2% of total medical costs.
The heights of total costs were more or less same among all DAS28 categories. However, the highest were costs for patients with high disease activity score. Hospital stays and surgery costs were the most relevant item for patients with the highest disease activity, these cost as well as the productivity ones could have been probably saved if biologic therapy was started earlier (within lover activity of disease).
This work was supportedby the grant number 000 000 23728 – Ministry of Health of Czech Republic.
Disclosure of Interest L. Sedova Grant/Research support from: Supported by grant 00000000023728 from the Ministry of health of Czech Republic, M. Vocelka: None Declared, J. Klimes: None Declared, T. Dolezal: None Declared