A review of the direct costs of rheumatoid arthritis - Managed care versusfee-for-service settings

Rheumatoid arthritis (RA) is a prevalent condition associated with pain, jo int destruction and morbidity. Direct healthcare costs are 2 to 3 times hig her than average costs for individuals of similar age and gender. Furthermo re, utilisation and costs rise with age and disease duration. Managed care has become an increasingly popular way to organise and finance the delivery of healthcare. Studies comparing the quality of care in healt h maintenance organisations and fee-for-service settings have found few dif ferences in outcomes, although reduced costs have been attributed to lower hospitalisation rates in patients with RA. We reviewed 10 studies of the di rect costs of RA. In 1996 dollars, direct costs ranged from $US2299 per per son per year in Canada to $US13549 in a US study focusing on patients who h ave been hospitalised only. Surprisingly, the contributions to direct costs - hospital care, medications and physician visits - remained relatively st able over time and the setting of care. Hospitalisation costs were the high est component of direct costs accounting, generally, for 60% or more of cos ts while only approximately 10% of patients with RA were hospitalised. The only exception was a managed care setting where hospitalisation costs were 16% of total direct costs. In managed care settings, costs of medications w ere proportionately higher than in fee-for-service settings. We conclude that in studies of the direct costs of RA the components of cos ts have remained relatively stable over time. This may change with the deve lopment and growing use of new RA medications including cyclo-oxygenase 2 i nhibitors, interleukins, cytokines, treatments that inhibit tumour necrosis factor, and combination therapies. The effectiveness of managed care in co ntrolling direct costs needs to be evaluated in more targeted studies.