PharmacoEconomics & Outcomes News 318 - 23 Jun 2001

Indirect costs far outweigh Lost productivity takes a heavy tollThe annual direct cost of RA to the Ontario healthcaretreatment costs in RA

system was calculated to be $Can36.8 million for mildA new Canadian study has reported that the indirect disease, $Can126.1 million for moderate disease,

costs associated with rheumatoid arthritis (RA) could $Can85.5 million for severe disease, and approximatelyexceed direct costs by a ratio of at least 3:1. Perhaps $Can2 million for disease in remission, adding up to amore importantly though, the study points out that even total of $Can250.5 million/year.in Canada where virtually all hospital and physician However, this figure represents only costs for suchexpenses are covered by a relatively comprehensive items as hospital stay, physicians’ and nurses’ costs, andpublicly funded healthcare system, patients with RA are inhospital use of drugs. Indirect costs are a differentstill left to pick up a substantial portion of the economic matter, Dr Wang said. It was determined, for example,burden themselves. The study was presented at the that anywhere from 12 to 29% of patients aged 45–64Canadian Health Economics Research Association’s 9th years who have RA – as many as 15 838 people inCanadian Conference on Health Economics [Toronto, Ontario – are unable to work because of the disease.Canada; May 2001], and could be the first in any major Based on a weighted average annual income of $Can34jurisdiction to look at the total economic burden of RA as 276, this means the total amount of lost incomea disease on its own, not merely as an ‘add-on’ to a study attributable to RA could range from $Can387.5 millionof osteoarthritis. to $Can542.8 million per year.

In an interview with PharmacoEconomics & Even patients with RA who continue to work still incurOutcomes News to discuss the study, Dr Ed Wang, productivity losses through taking time off to see theirassociate director of health economics for Wyeth Ayerst physician, reduced work hours to cope with the disease,Canada Inc., explained that although the mechanisms and restricted functioning while they are on the job. Theand pathophysiology of the disease are well known, little annual dollar value for lost productivity has beenis known about its economic burden. ‘We know that at estimated to be $Can4946 for each of the 26 352any given time anywhere from less than 1%, to around patients with RA in Ontario who continue to hold down2.5% of the population is likely to have this disease – let’s steady jobs – an estimated total of $Can130.3say around 1%, on average’, he said. ‘It’s a female to million/year.male ratio of 3:1, and the age of onset is between 35 and Total productivity losses which include permanent50, so it affects the working population. We believe that work disability and missed work associated with RAfor patients reaching the peak of their working lives, this range from $Can517.9 million to $Can673.2 million percould have a profound economic impact – never mind year, or $Can9711 to $Can12 624 per year for everythe quality-of-life impact that it would have as well.’ patient with RA in Ontario.

‘Part of the purpose of this study was to understand the Patients carry much of the costeconomic burden so we have a better grasp as aSo what does all of this mean for individual patientscompany on the cost of rheumatoid arthritis in Ontario’,

with RA in Ontario? The answer, unfortunately, is notDr Wang added.encouraging. The province’s publicly funded healthcareOntario is Canada’s largest and wealthiest provinceplan covers virtually all hospital and physician costs, aswith a population of 11 million and an annual publiclywell as costs for inhospital use of drugs, but the vastfunded healthcare budget of $Can42 billion.* Indeed, Drmajority of people with RA are caught in a state of limboWang’s presentation showed that the disease has anwhere their disease severely restricts their working lives,economic impact not just on the healthcare system as abut not enough to warrant hospitalisation. The provincewhole, but that it has a measurable impact ondoes not cover out-of-pocket expenses such asemployment, third-party payers and individuals’ out-of-nonprescription medications, or the cost of buying newpocket expenses.kitchen utensils with special grips, or even something

Average costs escalate with disease severity major such as having a bath or kitchen renovated toIn the study, 4 eminent rheumatologists who are accommodate a person’s restricted mobility. The

considered specialists in the treatment of RA in Canada province, in fact, only covers 50.6% of the total directbegan by putting the American College of Rheumatology costs, with the patient left to assume the balance.(ACR) descriptions of the disease into a clinically useful Private/employer insurance plans cover an estimatedcontext according to the number of swollen joints: mild, 46.5% of patient costs ($Can1954/patient/year),1–5 swollen joints; moderate, 6–18 swollen joints; and meaning that patients are still responsible for $Can66severe, > 18 swollen joints. ‘The ACR definitions spell million/year in out-of-pocket treatment expenses.out disease stages, but do not define them as mild, ‘Because RA is a chronic disease that does not requiremoderate or severe’, Dr Wang explained. ‘Mild, too much hospitalisation, and hospitalisation is paid formoderate and severe classifications are more of a clinical entirely by the government, this means a lot of the costsjudgement, and to be able to establish the economic are outpatient costs, or costs that are not paid for by theburden of the disease, we needed a Canadian baseline. government. The government is only footing half the bill’,We felt that it gave a lot more credibility to the study to Dr Wang said.have locally validated clinical practice patterns.’ ‘This is a disease that has a lot of patient-borne costs,

The expert panel also established that approximately and that is something that we uncovered with this study,40% of Canadians with RA have mild disease, 20–30% perhaps because it’s chronic, it’s not acute, it’s not life-have moderate disease and 30–40% have severe threatening, that’s why the patient ends up paying a gooddisease. It was further determined that the average chunk of the cost.’annual per-patient cost amounts to $Can1522, * Canadian dollars$Can2926 and $Can4628 for mild, moderate, and

Johnston C. Indirect costs far outweigh treatment costs in RA.severe RA, respectively. Even disease in remission costsPharmacoEconomics and Outcomes News 318: 23 Jun 2001 800840443

an estimated $Can918/patient/year.

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PharmacoEconomics & Outcomes News 23 Jun 2001 No. 3181173-5503/10/0318-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved