Medical Care Costs Associated With Rheumatoid Arthritis in the US: A Systematic Literature Review and Meta-Analysis

Abstract

Objective: Rheumatoid arthritis (RA) is a morbid, mortal, and costly condition without a cure. Treatments for RA have expanded over the last 2 decades, and direct medical costs may differ by types of treatments. There has not been a systematic literature review since the introduction of new RA treatments, including biologic disease-modifying antirheumatic drugs (bDMARDs).

Methods: We conducted a systematic literature review with meta-analysis of direct medical costs associated with RA patients cared for in the US since the marketing of the first bDMARD. Standard search strategies and sources were used, and data were extracted independently by 2 reviewers. The methods and quality of included studies were assessed. Total direct medical costs as well as RA-specific costs were calculated using random-effects meta-analysis. Subgroups of interest included Medicare patients and those using bDMARDs.

Results: We found 541 potentially relevant studies, and 12 articles met the selection criteria. The quality of studies varied: one-third were poor, one-third were fair, and one-third were good. Total direct medical costs were estimated at $12,509 (95% confidence interval [95% CI] 7,451-21,001) for all RA patients using any treatment regimen and $36,053 (95% CI 32,138-40,445) for bDMARD users. RA-specific costs were $3,723 (95% CI 2,408-5,762) for all RA patients using any treatment regimen and $20,262 (95% CI 17,480-23,487) for bDMARD users.

Conclusion: The total and disease-specific direct medical costs for patients with RA is substantial. Among bDMARD users, the cost of RA care is more than half of all direct medical costs.

Figure 1

shows the assembly of literature for the systematic literature review.

Figure 2

shows the meta-analysis results for the direct medical costs. Panel A demonstrates the total cost of care for all patients. Panel B demonstrates the total cost of care for biologic DMARD users only. Panel C demonstrates rheumatoid arthritis-specific costs of care for all patients. Panel D demonstrates rheumatoid arthritis-specific costs of care for biologic DMARD users only. Multiple papers included in these meta-analyses reported cost of care findings for several distinct patient populations. These distinct populations are each treated as individual contributors to the meta-analysis and are listed with the identifying characteristic of the patient population studied (e.g. individual year or specific drug treatment regimen).

Figure 2

shows the meta-analysis results for the direct medical costs. Panel A demonstrates the total cost of care for all patients. Panel B demonstrates the total cost of care for biologic DMARD users only. Panel C demonstrates rheumatoid arthritis-specific costs of care for all patients. Panel D demonstrates rheumatoid arthritis-specific costs of care for biologic DMARD users only. Multiple papers included in these meta-analyses reported cost of care findings for several distinct patient populations. These distinct populations are each treated as individual contributors to the meta-analysis and are listed with the identifying characteristic of the patient population studied (e.g. individual year or specific drug treatment regimen).

Figure 2

shows the meta-analysis results for the direct medical costs. Panel A demonstrates the total cost of care for all patients. Panel B demonstrates the total cost of care for biologic DMARD users only. Panel C demonstrates rheumatoid arthritis-specific costs of care for all patients. Panel D demonstrates rheumatoid arthritis-specific costs of care for biologic DMARD users only. Multiple papers included in these meta-analyses reported cost of care findings for several distinct patient populations. These distinct populations are each treated as individual contributors to the meta-analysis and are listed with the identifying characteristic of the patient population studied (e.g. individual year or specific drug treatment regimen).

Figure 2

shows the meta-analysis results for the direct medical costs. Panel A demonstrates the total cost of care for all patients. Panel B demonstrates the total cost of care for biologic DMARD users only. Panel C demonstrates rheumatoid arthritis-specific costs of care for all patients. Panel D demonstrates rheumatoid arthritis-specific costs of care for biologic DMARD users only. Multiple papers included in these meta-analyses reported cost of care findings for several distinct patient populations. These distinct populations are each treated as individual contributors to the meta-analysis and are listed with the identifying characteristic of the patient population studied (e.g. individual year or specific drug treatment regimen).