Background/Purpose: Previous studies suggest that early rheumatoid arthritis (RA) recognition and treatment provides greater clinical benefits than treatment started later in the disease course. However, the impact of early treatment initiation on the total cost of care in RA patients has not been well studied. Additional data on the clinical and economic impact of RA in the US are required to provide better information for healthcare and health policy decision-making. The purpose of this study was to determine the medical cost savings of a timely RA diagnosis 6 months pre-and post-diagnosis.

Methods: This retrospective cohort study evaluates newly diagnosed RA patients insured by a large commercial and Medicare health plan in the United States between January 1, 2019 and December 31, 2019. We defined a “late” RA diagnosis as a patient diagnosed for the first time as part of an emergency department (ED)/inpatient (IP) setting as these patients likely had symptoms of RA prior to this visit but were not properly diagnosed. We defined a “timely” RA diagnosis as a patient diagnosed for the first time in an in-office setting. We defined newly diagnosed as a patient who had medical insurance but no paid claim for RA for at least six months before the initial claim with an RA diagnosis. We defined diagnosis in the ED/IP setting as patients with their first RA claim in an ED/IP setting. A Targeted Likelihood Estimation Model (TMLE) was used to assess relationships between patient characteristics and the total cost of care per member (PM) 6 months before and 6 months after diagnosis.

Results: The study included 42,350 patients with a new RA diagnosis in 2019, the majority were female (69.3%) and the mean age was 59.4 years (SD = 16.8). Ten percent of the new RA cases were diagnosed in an ED/IP setting (late diagnosis). The total cost of care 6 months pre-diagnosis was driven by an increase in ED costs (a $418 PM over 6 months increase for commercial patients (p< 0.001) and a $547 PM over 6 months increase for Medicare patients (p< 0.001)) and IP costs (a $2,712 PM over 6 months increase for commercial patients (p< 0.001) and a $1,341 PM over 6 months increase for Medicare patients (p< 0.001)). After adjusting for risk score and demographic characteristics, the adjusted total cost of care PMPY for new RA patients diagnosed in an ED/IP setting was higher than new RA patients diagnosed in other settings by a $4,055 PM over 12 months increase (p< 0.01) in commercial patients and a $1,670 PM over 12 months increase (p< 0.01) in Medicare patients. Most of the increase in cost occurred during the 6 month period pre-diagnosis, there was no significant difference in total cost of care in the 6 month post-diagnosis period.

Conclusion: In this study, a late RA diagnosis was associated with a significantly higher total cost of care, compared to a timely RA diagnosis; a trend that was observed for both commercial and Medicare patients. Newly diagnosed RA patients in an ED/IP setting spent significantly more on IP and ED costs prior to their RA diagnosis. Future studies are needed to identify and predict patients at risk of developing RA to reduce unnecessary healthcare costs of a delayed diagnosis.

Table 1. Demographic Characteristics of Newly Diagnosed RA Patients in 2019.

Table 2. Total Spend Differences Between Patients Diagnosed in an ED/IP Setting and Patients Diagnosed in Other Settings by Type of Insurance

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/medical-savings-of-timely-rheumatoid-arthritis-diagnoses/