Background Whereas several studies have estimated various aspects of the economic burden of RA in defined cohorts of patients, few studies from the biologic era have had the possibility to simultaneously assess several cost components using nationwide data or put these costs in relation to general population comparators.
Objectives To estimate the societal annual costs related to work loss, health care utilization, and drug use in contemporary prevalent RA patients.
Methods RA patients ≥18y on Jan 1, 2009, were identified from the Swedish National Patient Register (requiring ≥2 visits listing RA) and the Swedish Rheumatology Quality Register, and followed until Dec 31, 2009. Sick leave and disability pension data were retrieved from the Social Insurance Office, while healthcare utilization, drug use, and mortality data were retrieved from the national and virtually complete Patient Register, Prescribed Drug Register and Causes of Death Register, respectively. Five sex-, age-, education-, and county-matched general population comparators were sampled per RA patient from the Register of the Total Population. Prevalent RA patients exposed to biologics (for these analysis defined as dispensings of etanercept or adalimumab in 2008) were evaluated in subgroup analyses.
Results We identified 51,193 RA patients, alive and living in Sweden Jan 1, 2009 (mean age 64y; estimated prevalence=0.7%). The mean total costs for individuals aged 18-64y were €22,000 (median €15,000) per RA patient vs €8,000 (median €300) per matched general population comparator. Although the mean cost level differed, the distributions of the cost components in the RA patients and the general population comparators were similar. In both groups disability pension (66% vs 72% of total cost) contributed by far the most, followed by sick leave (9% vs 12%) and biologic drug use (10% in RA patients). In RA patients ≥65y the mean direct cost was €8,000 vs €3,000 (median €2,000 vs €700) in the general population comparators. Inpatient care dominated (63% vs 68%), followed by drug use (22% vs 16%) and non-primary outpatient care (15% vs 15%). In RA patients exposed to biologics the mean total cost was €31,000 and €17,000 (median €26,000 and €15,000) in the 18-64y and ≥65y age group, respectively, with biologics accounting for €10,000 in both groups.
Conclusions The mean total cost in RA patients was 2-3 times higher than in matched general population comparators. With the exception of biologic drugs, the included cost components were of comparable magnitude in all RA patients as in the RA patients exposed to biologics.
Disclosure of Interest None Declared