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Joint Bone Spine
Volume 71, n° 6
pages 518-524 (novembre 2004)
Doi : 10.1016/j.jbspin.2004.01.003
Received : 22 April 2003 ;  accepted : 8 January 2004
Rheumatoid arthritis: direct and indirect costs
 

Anne-Christine Rat a, b, Marie-Christophe Boissier a, b,
a Rheumatology Department, Avicenne Teaching Hospital (AP-HP), 125, route de Stalingrad, CHU Avicenne, 93009 Bobigny cedex, France 
b UPRES EA-3408, UFR Léonard de Vinci, Paris North University, Bobigny, France 

*Corresponding author.
Abstract

Rheumatoid arthritis (RA) causes disability, deformities, progressive radiological joint damage often with a need for joint replacement surgery, premature death, and alterations in quality of life. The economic burden created by RA is enormous. Direct costs per patient have been estimated at 1812–11 792 € annually and indirect costs at 1260–37 994 € annually. These mean values are approximations, as variations occur across countries, healthcare system organizations, and geographic locations. Direct costs account for one-fourth to slightly over a half of the total cost. Costs associated with inpatient care contribute up to 75% of direct costs, as compared to only about 20% for medications, although wide variations occur in costs related to drug monitoring and side-effect management. Physician visits account for about 20% of direct costs. As compared to indirect health costs for individuals from the general population, those for RA patients are increasing at a rapid rate. Indirect costs account for 80% of the excess cost related to RA. Cost estimates may change over time and show huge variations across individuals, with a small minority of patients accounting for most of the costs. Disability as measured by the Health Assessment Questionnaire (HAQ) has a major impact on costs. Early effective treatment may not only postpone and slow disease progression, thereby improving quality of life, but also decrease costs by preserving productivity and reducing the need for surgery, admission to acute-care and extended-care hospitals, and social service utilization. Data are beginning to accumulate on the excess costs associated with biotherapies and other new second-line drugs. They indicate acceptable excess costs relative to the additional medical benefits and to the cost-effectiveness of other healthcare programs. Nevertheless, the threshold that defines an acceptable excess cost is arbitrary and varies with local economic conditions.

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Keywords : Rheumatoid arthritis, Health economics, Costs




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