Rheumatoid arthritis is already expensive during the first year of the disease (the Swedish TIRA project)

• Published in: Rheumatology (Oxford, England) Vol. 43; no. 11; pp. 1374 - 1382
• Main Authors: Hallert, E., Husberg, M., Jonsson, D., Skogh, T.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2004; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Arthritis, Rheumatoid - economics; Arthritis, Rheumatoid - therapy; Biological and medical sciences; Complementary Therapies - economics; Cost of Illness; Direct costs; Disability Evaluation; Diseases of the osteoarticular system; Drug Costs; Early rheumatoid arthritis; Female; Health Care Costs - statistics & numerical data; Health Services - utilization; Health Status Indicators; Hospital Costs - statistics & numerical data; Humans; Indirect costs; Inflammatory joint diseases; Logistic Models; Male; Medical sciences; MEDICIN; MEDICINE; Middle Aged; Outcome; Prospective Studies; Sick Leave - statistics & numerical data; Surveys and Questionnaires; Sweden; Sweden; Europe; Costs; Prognosis; Cost of illness; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Indirect costs; Swedish; Project; Chronic; Direct costs; Rheumatoid arthritis; Outcome; Early; Early rheumatoid arthritis
• ISSN: 1462-0324; 1462-0332; 1462-0332
• DOI: 10.1093/rheumatology/keh324

Objective. To calculate direct and indirect costs in early rheumatoid arthritis (RA) and to characterize patients generating high and low costs respectively. Methods. Two hundred and ninety-seven patients with recent-onset (≤12 months) RA were recruited. Clinical/laboratory data and ‘health assessment questionnaire’ (HAQ) were registered at inclusion and after 3, 6 and 12 months. After 6 and 12 months, the patients completed a questionnaire concerning health-care utilization and days lost from work. A cut-off point for direct costs was set at 34 000 Swedish kronor (€3675) defining one-third of the patients as a high-cost group and two-thirds as low-cost group. Indirect costs were calculated for patients aged <65 yr. Results. Two hundred and eleven patients completed the HAQ on both occasions. Indirect costs exceeded direct costs by a factor of 2.3. Sixty three per cent experienced work disability during the first year and were identified as the ‘high-indirect-cost group’. Indirect costs accounted for >70% of total costs. Direct costs included ambulatory health care (76%), hospitalization (12%) and medication (9%). Men aged ≥65 yr had low costs compared with younger men and women of all ages. In multiple logistic regression tests, HAQ, high levels of IgM rheumatoid factor (IgM RF) and poor hand function increased the odds of entering the high-direct-cost group, and poor hand function and pain increased the odds of entering the high-indirect-cost group. Conclusions. Substantial costs were incurred during the first year after diagnosis of early RA, mainly due to work disability. Indirect costs were two to three times higher than direct costs. High levels of IgM RF, high HAQ score, poor hand function and pain increased the odds of entering high-cost groups.