How do multiple long-term conditions impact on the cost-of-illness in early rheumatoid arthritis?

Hsieh, P. H., Geue, C. , Wu, O. , McIntosh, E. and Siebert, S. (2022) How do multiple long-term conditions impact on the cost-of-illness in early rheumatoid arthritis? RMD Open, 8, e002454. (doi: 10.1136/rmdopen-2022-002454) (PMID:36104116) (PMCID:PMC9476122)

Abstract

Objective: Multiple long-term conditions (MLTCs) are prevalent in rheumatoid arthritis (RA) and associated with worse outcomes and greater economic burden. However, little is known about the impact of MLTCs on the cost-of-illness (COI) in early RA, including direct and indirect costs. The objective of this study was to quantify this impact on COI. Methods: The Scottish Early Rheumatoid Arthritis study is a national cohort of adults with new-onset RA. Direct costs were estimated applying relevant unit costs to health resource utilisation; indirect costs were measured by productivity loss due to health conditions. Two-part models were used, adjusting for age, gender, baseline functional disability and health-related quality of life. The Charlson Comorbidity Index score was calculated using ICD-10 diagnoses. Individuals were defined as ‘RA alone’, ‘RA plus LTC’ and ‘RA plus MLTCs’ according to the number of coexisting LTCs. Results: Data were available for 818 participants. Average annualised direct costs incurred by people with early RA plus MLTCs (£4444; 95% CI £3100 to £6371) were twice as, and almost five times higher than, those with a single LTC (£2184; 95% CI £1596 to £2997) and those without LTC (£919; 95% CI £694 to £1218), respectively. Indirect costs incurred by RA plus MLTCs (£842; 95% CI £377to £1521) were 3.1 times higher than RA alone (£530; 95% CI £273to £854). The relative proportion of direct costs increased with LTC category, ranging from 77.2% to 84.1%. In addition to increased costs with LTCs, costs also increased with age and were higher for men regardless of LTC category. Conclusions: MLTCs impact on COI early in the course of RA. The presence of LTCs is associated with significant increases in both direct and indirect costs among people with early RA.

• Item Type: Articles
• Additional Information: The SERA study was jointly supported by the Chief Scientist’s Office Scotland (ETM-40) and Pfizer Ltd. PHH is funded by National Defense Medical Center, Taiwan through a PhD scholarship.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Siebert, Professor Stefan and Wu, Professor Olivia and McIntosh, Professor Emma and Geue, Dr Claudia and Hsieh, Ping Hsuan
• Authors: Hsieh, P. H., Geue, C., Wu, O., McIntosh, E., and Siebert, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: RMD Open
• Publisher: BMJ Publishing Group
• ISSN: 2056-5933
• ISSN (Online): 2056-5933
• Published Online: 14 September 2022
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2022
• First Published: First published in RMD Open 8: e002454
• Publisher Policy: Reproduced under a Creative Commons License