Cost of illness in rheumatoid arthritis in Germany in 1997–98 and 2002: cost drivers and cost savings

Objective. Comparison of overall RA-related costs and of relative contribution of single-cost domains before and after the introduction of TNF-blocking agents in Germany. Methods. Two cohorts of RA outpatients (ACR ’87 criteria) with long-standing disease are assessed in terms of disease-related costs and cost composition (n = 106 patients in 199798 and n = 180 patients in 2002 with similar patient characteristics). Full-cost analyses are performed including direct disease-related costs (medical and non-medical) and productivity costs as collected by patient questionnaires. Absolute costs (E/patient/year) are compared and the impact of single-cost domains on overall costing in RA is estimated (relative proportions of cost components within samples). Results. Overall costs are comparable (199798: E4280; 2002: E3830; not significant). Differences can be observed in medication (199798: E550; 2002: E1580; P < 0.001) and hospitalization costs (199798: E1240; 2002: E500; P < 0.001). Productivity costs are significantly lower (E1480 vs E850; P < 0.05) in 2002. The impact of medication costs is outstanding in the 2002 sample (42 vs 12%), the proportion of hospitalization costs is substantially lower (29 vs 13%). Costs for DMARDs in 2002 are mostly driven by TNF blockers (37%). The number of DMARDs per patient is higher in 2002 as are costs for osteoporosis medication and gastroprotective treatment. Conclusion. Although overall costs before and after the introduction of TNF blockers are comparable, the decrease in hospitalization and productivity costs is promising in terms of future long-term cost savings. The development of these aspects and of the increasing medication costs will have to be evaluated with longer time frames.