Medical therapy for rheumatoid arthritis—value for money?

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Abstract
The economic burden of rheumatoid arthritis (RA) is considerable and has been well documented [1–4]. The cost of managing the disease approximates to that of treating ischaemic heart disease [1] and several studies have suggested that the direct costs of treating patients with RA are two to three times higher than age‐ and sex‐matched subjects without arthritis [3–5]. In addition, the cost of treating comorbidity is also higher in patients with RA than in non‐RA controls [5]. In England, the total economic impact of RA has been estimated to be £1.256 billion, over half of which is accounted for by loss of earnings [6]. In‐patient and long‐term institutional care account for over 50% of the direct medical cost, while the cost of drugs, including monitoring and toxicity management, accounts for only about 15%. A similar distribution of cost was reported in a recent systematic review of the economics of RA where between 8 and 24% of the direct cost of treating RA was on drugs, monitoring and treating side‐effects [7]. Requirements for daily care, assistive devices and home modifications are three times higher than in non‐arthritic controls [8]. Yet even these data fail to express adequately the overall economic impact of the disease. This is due largely to the fact that the so‐called indirect costs of RA, of which a major component is loss of productivity due to morbidity and premature death, at least equal and, in many studies, far outweigh the direct costs [3, 9]. Loss of employment occurs early in RA, with recent evidence suggesting that many patients give up work prior to their first contact with a rheumatologist and certainly before they have received a disease‐modifying anti‐rheumatic drug (DMARD) [10].