Background Rheumatoid arthritis is a chronic and debilitating disease which decrease quality of life and productivity.
Objectives Rheumatoid arthritis (RA) has significant economic implications for the individual patient as well as society as a whole. Annual RA treatment costs of €4,000 in France, €5,028 in the Netherlands and €9,946 in Belgium. Yet for Turkey, the cost of care has not been analyzed using real-world clinical data. We aimed to identify factors associated with the cost of RA care and calculate risk-adjusted costs associated with RA in Turkey. We also examined the relationships between costs of RA treatment and global disease activity.
Methods This cross-sectional study was performed in 10 tertiary rheumatology centers. Eligible patients were ≥18 years of age and diagnosed with RA for at least 12 months according to the American College of Rheumatology (ACR) 1987 criteria. Overall costs were categorized as inpatient, outpatient and pharmacy. Generalized linear models were used to calculate risk-adjusted direct costs. After using the Park test, the Gamma family with log link was chosen for the model.
Results A total of 698 patients (82% female; mean age: 51.2 ± 13.17 standard deviation [SD] years) were studied. Patients’ visual analog scale (VAS), patient’s global disease activity (GDA) and routine assessment of patient index data 3 (RAPID-3) scores were on average 44.15, 5.19 and 5.10 respectively. Most patients were prescribed immunosuppressive medication and glucorticoids (87.8% and 61.2%, respectively). After adjusting all variables (demographic and clinical characteristics, comorbid conditions and medication use), total annual medical costs was €2,671. The most significant portion of overall expenditures was due to pharmaceutical costs €1,987, while outpatient costs were €303, inpatient costs were €360 and co-payments were €21. 14% of patients experienced work loss due to RA. On average, annual costs due to workday loss were €480. 5.4% of patients also had other RA-related consultations, which were not covered by insurance, bringing the average annual burden to €1,600 for these patients. 6.5% of RA patients incurred additional costs related to their condition such as the need for a new car, apartment or special equipment, spending an additional €1,640 in 1 year. 13.7% of patients required caregivers. The average annual out-of-pocket amount paid to caregivers was €624. There was a negative relationship between money spent on RA treatment and VAS, GDA and RAPID-3.
Conclusions The annual medical cost of RA is significantly lower in Turkey relative to European estimates. With higher expenditures, there is a potential for a decrease in disease activity.
Acknowledgements This study was sponsored by Pfizer Turkey
Disclosure of Interest V. Hamuryudan: None Declared, H. Direskeneli: None Declared, I. Ertenli: None Declared, M. İnanç: None Declared, Y. Karaaslan: None Declared, F. Oksel: None Declared, S. Özbek: None Declared, S. Pay: None Declared, E. Terzioğlu: None Declared, B. Durguner Employee of: Pfizer, O. Başer: None Declared, N. Akkoc: None Declared