Costs for hospital care, drugs and lost work days in incident and prevalent rheumatoid arthritis: how large, and how are they distributed?

Objective: To estimate the costs related to hospital care, drug use and work loss in prevalent and incident patients with rheumatoid arthritis (RA), and to describe their distribution.

Methods: A cohort of prevalent patients with RA ≥18 years on Jan 1, 2010, was identified from the Swedish National Patient Register (requiring ≥2 visits listing RA) and the Swedish Rheumatology Quality Register, and followed until 31 December 2010. From the same registers, patients with the 1st visit listing RA in 2009, with a 2nd visit within 1 year, were identified to the incident cohort, and were followed for 1 year. Five sex-matched, age-matched, education-matched and county-matched general population comparators were sampled per patient with RA. Costs were retrieved from national registers.

Results: The mean annual cost, including productivity losses per patients with RA (n=49 829) aged 18-64 years was €23 147 versus €8364 (median €15 059 vs €277) per comparator. In patients with RA ≥65 years, the mean healthcare cost was €6438 versus €2773 (median €2458 vs €677) per comparator. 13% of the patients accounted for 50% of the cost. For the incident patients with RA (n=2695), the mean monthly cost increased from a level close to the comparators 1 year before register identification (18-64 years: €736 vs €644; ≥65 years: €192 vs €178), peaked the month following the identification date, and decreased to twice the cost of the comparators 1 year after diagnosis (18-64 years: €1252 vs €628; ≥65 years: €487 vs €230).

Conclusions: The mean annual cost in patients with established RA, and mean monthly cost in newly diagnosed patients with RA, were 2-3 times higher than in the general population.