Rheumatoid arthritis patients with comorbid depression and/or cardiovascular disease accumulated thousands more dollars in annual health care costs than did their peers with RA alone.
This finding is based on a study of over 10,000 people with rheumatoid arthritis conducted by Amie T. Joyce of Pharmetrics Inc., Watertown, Mass., and her associates.
In an interview, Edward H. Yelin, Ph.D., an expert on the economic impacts of chronic diseases who was asked by this publication to comment on this research, said “We are seeing increasingly that inflammation [is present in] many chronic diseases and, thus, it is impossible to separate out specific illness costs perfectly.”
Rheumatologists can help bring down utilization costs for these patients “by treating the whole person, rather than just the single most pressing condition,” said Dr. Yelin, who was not involved in the study. He is professor in residence of medicine and health policy in the division of rheumatology at the University of California, San Francisco.
Dr. Joyce's study looked at 10,298 RA patients culled from PharMetrics Inc.'s patient-centric database from 2001 to 2005. The database contains medical and pharmaceutical claims from 92 health plans across the United States. Of the sample, 8,916 patients (87%) had RA alone, 608 (6%) had RA with CVD, 716 (7%) had RA with depression, and 58 (0.6%) patients had all three conditions.
The annual cost for patients with RA alone was $14,257 vs. $21,410 for patients with RA plus depression, $24,444 for patients with RA plus CVD, and $35,246 for all three conditions.
Patients with RA plus depression had higher annual RA-specific costs than did patients with RA alone ($9,940 vs. $9,322; P = .014), and the RA-specific costs increased even more in patients with all three conditions, to $12,318 (P = .012). That effect was not seen in the RA plus CVD group (J. Rheumatol. 2009 Feb. 15 [doi:10.3899/jrheum.080670]).
Hospitalization contributed to the increased costs. Just 8% of patients with RA alone had a hospital stay in the 12 months prior to their index date (the date of the patient's first claim with an RA diagnosis). In the RA plus CVD cohort, this jumped to 35%. In the RA plus depression cohort, it was 19%, and among the patients who had all three diagnoses, 60% were hospitalized during that 12-month period. (For all rates, P was less than .001.)
The average number of prescriptions filled also increased with increasing comorbidities. RA-only patients filled an average of 46.8 prescriptions in the 12 months following RA diagnosis, compared with 69.2 in the RA plus CVD group, 71.3 in the RA plus depression group, and 114.3 in the RA plus depression plus CVD group.
The authors disclosed funding from Wyeth Research. Three of the authors are also Wyeth Research employees.