Costs for hospital care, drugs and lost work days in incident and prevalent rheumatoid arthritis: how large, and how are they distributed?

Objective To estimate the costs related to hospital care, drug use and work loss in prevalent and incident patients with rheumatoid arthritis (RA), and to describe their distribution. Methods A cohort of prevalent patients with RA >= 18 years on Jan 1, 2010, was identified from the Swedish National Patient Register (requiring >= 2 visits listing RA) and the Swedish Rheumatology Quality Register, and followed until 31 December 2010. From the same registers, patients with the 1st visit listing RA in 2009, with a 2nd visit within 1 year, were identified to the incident cohort, and were followed for 1 year. Five sex-matched, age-matched, education-matched and county-matched general population comparators were sampled per patient with RA. Costs were retrieved from national registers. Results The mean annual cost, including productivity losses per patients with RA (n=49 829) aged 18-64 years was (sic)23 147 versus (sic)8364 (median (sic)15 059 vs (sic)277) per comparator. In patients with RA >= 65 years, the mean healthcare cost was (sic)6438 versus (sic)2773 (median (sic)2458 vs (sic)677) per comparator. 13% of the patients accounted for 50% of the cost. For the incident patients with RA (n=2695), the mean monthly cost increased from a level close to the comparators 1 year before register identification (18-64 years: (sic)736 vs (sic)644; >= 65 years: (sic)192 vs (sic)178), peaked the month following the identification date, and decreased to twice the cost of the comparators 1 year after diagnosis (18-64 years: (sic)1252 vs (sic)628; >= 65 years: (sic)487 vs (sic)230). Conclusions The mean annual cost in patients with established RA, and mean monthly cost in newly diagnosed patients with RA, were 2-3 times higher than in the general population.