ACR: High Cost of Rheumatoid Arthritis in the Elderly

Elderly patients with rheumatoid arthritis (RA) have significantly greater comorbidities, health care resource utilization (HCRU), and cost compared to those without.

“Elderly patients with RA experience a dispropor­tionate burden of disease related to comorbidities when compared to age-matched controls, and that in part drives up health care resource utilization nearly 3-fold for patients with RA,” said Kristine Phillips, MD, PhD, assistant professor of internal medicine, University of Michigan Medical Center, who presented data at the 2015 American College of Rheumatology Annual Meeting from a study that compared HCRU, cost, and comorbidities in elderly patients with RA in the US compared to patients without RA.

The study was done to fill a gap on the limited data currently available on the burden of RA in the elderly in the United States, despite recognition of the overall burden of RA on US health care resource utilization and cost.

Dr Phillips and colleagues used Medicare fee-for-service claims data from 2010 through 2013 to collect data on patients with RA >65 years of age with at least 2 medical claims of a diagnosis of RA and at least 1 pharmacy claim for a disease-modifying antirheu­matic drug (DMARD), as well as on a control cohort of elderly patients without RA.

Using an index date as the time of the first DMARD prescription for RA patients and as the time of ran­domized assignment for the patients without RA, the study compared the all-cause and RA-related HCRU and costs between the patients with RA and those without RA during the 12 months after the index period.

 A total of 231,734 patients were included in the study, 115,867 patients with RA and 115,867 without RA. The average age in both cohorts was 75 years, and most patients were women (79.4%), white (86.2%), and lived in the southern United States (41.3%).

Based on the Charlson Comorbidity Index excluding RA, the study found that elderly pa­tients with RA had a significantly greater overall comorbidity burden than elderly patients without RA (1.86 vs 1.00; P<.0001). At baseline, the RA patients had significantly higher rates of hypertension, hyperlipidemia, respiratory disease, diabetes, osteoporosis, and cardiovascular disease (P<.0001 for all individual comorbidities).

The most common comorbidities included hy­pertension, lipid disorders, and pulmonary disease.

In terms of cost, the study found that elderly patients with RA had significantly higher HCRU that resulted in nearly 3-fold higher annual health care costs compared to non-RA patients.

The total mean annual health care costs were $20,919 for patients with RA and $7197 for patients without RA. About half of the costs for the RA patients were not related to RA, with an annual mean health care cost of $11,587 for RA-related costs.

According to the study, even after controlling for differences in comorbidities and patient characteris-tics  between the 2 cohorts, the adjusted total mean annual costs were still more than double for the patients with RA compared to the patients without RA ($16,374 vs $6712, P<.0001).

“These results suggest that rheumatoid arthritis alone is the major driver of overall costs in this patient population,” said Dr Phillips.—Mary Beth Nierengarten