Background/Purpose: The range of medical costs associated with rheumatoid arthritis (RA) is, in part, related to the various treatment options. Treatment for RA focuses on the control and management of inflammation. Patients with new RA diagnoses or less severe disease are usually prescribed less expensive non-biologic disease-modifying antirheumatic drugs (DMARDs). In contrast, patients who do not respond to DMARD treatment or exhibit more advanced disease are treated with biologics. It is estimated that treating RA with biologic therapies is three times more expensive than nonbiologic DMARDs. However, the initial cost of biologic therapy may be offset through reduced disease progression, health care utilization, and health care expenditures throughout the disease. The purpose of this study was to estimate the total cost of care among RA patients with commercial health insurance.

Methods: We identified patients with RA using medical claims data from January 1, 2019, to December 31, 2019. We defined total cost of care as the sum of allowed costs paid for medical and pharmacy claims per year. We compared the allowed costs of fully-insured and self-insured commercial patients with health insurance through a large national insurer.

Results: From January 2019 to December 2019, we identified 7,489 fully-insured RA patients and 11,824 self-insured RA patients. The average annual total cost of care for fully-insured and self-insured patients was $31,561 and $33,753, respectively. Pharmacy costs (both medical and pharmacy benefits) accounted for 70% of total costs for fully-insured and self-insured patients. Inpatient facility, specialist physician and ambulatory facility costs accounted for 9%, 7% and 5%, respectively, of total costs for fully-insured and self-insured patients. In 2019, 622 patients were prescribed infliximab for the treatment of RA, the majority of these patients (72%) received infusions in their doctor’s office. The annual total cost of care for patients on infliximab ranged from $57,612 for those receiving infusions in their doctor’s office to $131,616 for those receiving infusions in a hospital.

Conclusion: Direct medical costs for patients with RA are significant. In this study, pharmacy costs comprised a substantial portion of RA total cost of care. While pharmacy costs comprise a significant portion, the actual amount spent varies significantly by type of therapy and site of care, which presents an opportunity of future study and potential optimization of cost outcomes.

Figure 1. Total Cost of Care Distribution for Members with Rheumatoid Arthritis, 2019

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/total-cost-of-care-for-patients-with-rheumatoid-arthritis/