Background/Purpose: Rheumatoid Arthritis (RA) has differing therapeutic outcomes, with resulting differences in function and quality of life. Little is known about the effects of disease activity states on costs of routine care of people with RA. We quantified the real medical costs of treating patients with RA who were in a high DAS28 state (HDAS) versus low DAS28 or remission (LDAS), in a Guys & St Thomas’ NHS Foundation Trust (GSTT) and Roche Products Ltd collaborative project.

Methods: The GSTT RA Centre database of 1,700 patients with RA, was used to generate two groups of 60 patients with high DAS28 (DAS28>5.1) scores and low DAS/remission, matched in terms of age, sex and duration of disease. Patients with co-morbidities such as significant chronic medical conditions, cancer and fibromyalgia were excluded to ensure comparable groups. Health Assessment Questionnaire (HAQ-DI) and EQ-5D values were compared. All medical costs incurred at GSTT from August 2013 to September 2015 were collated, including drug costs, inpatient and outpatient procedures and investigations.

Results: The mean and range for average HAQ-DI and EQ-5D respectively was 1.78 (0.15-2.92) and 0.286 (0.691 – [-0.239]) for the HDAS group and 0.70 (0-2.31) and 0.714 (1-0.258) for the LDAS group, both significantly different. Total GSTT pharmaceutical costs were £390,904, with biologic drug costs of £377,507 for HDAS patients and £324,805, with biologic drug costs of £321,401, for LDAS patients. 17 people in the HDAS group took concomitant prednisolone compared to 5 in the LDAS group. Total costs for the HDAS group were £733.984.02 ($1,078,957) vs £483,755.97 ($711,121) for the LDAS group, a difference of £250,228.05 ($367,835). Costs for patients living near our centre to those living at a distance did not differ significantly indicating that much of their hospital care took place at GSTT. The annual GSTT cost per patient increment of HDAS RA vs LDAS RA was £2085 ($3,066). These costs do not capture non-GSTT healthcare costs.

Conclusion: This study describes ‘real world’ hospital costs of treating patients with rheumatoid arthritis who have different disease activity, with minimal co-morbidity differences, treated by the same team. Poor function and quality of life for those people in high disease activity despite higher use of concomitant steroids and similar biologic drug use, shows the challenging nature of their RA. The data further support strategies to treat early and effectively by demonstrating that patients with low disease activity has a lower cost impact on the Trust and improved function and quality of life scores.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-life-cost-of-uk-healthcare-resource-for-patients-with-rheumatoid-arthritis-comparing-high-and-lowremission-disease-states/