AB1326 Rheumatoid arthritis 6 years after diagnosis – still associated with high direct costs and increasing loss of productivity (the swedish TIRA project)

Background Previous reports from the TIRA cohort have shown that total costs were unchanged during the first 3 years after diagnosis of early rheumatoid arthritis (RA). Ambulatory visits and hospitalization decreased but surgery and drugs increased. Sick leave also decreased, but was offset by early retirement, resulting in unchanged net costs. The present study reflects a period of 6 years after diagnosis, during which there was a paradigm shift, with biological drugs being introduced around year 3. Objectives To calculate direct and indirect costs during 6 years after diagnosis and analyze changes in health care utilization and development of working capacity. Methods One-hundred and twenty-five patients with early (≤1 year) RA, recruited 1996-98, were assessed during 6 years from diagnosis. Clinical and laboratory data were collected and patients were provided with diaries and reported prospectively all health care utilization and number of days lost from work. Annual direct and indirect costs and EQ-5D scores were calculated. Costs were also compared between patients prescribed biologics and non-users. Results Outpatient visits and days in hospitalization decreased during the first 3 years, but costs for surgery and drugs increased. Around year 3, biologics were introduced. Direct costs continued to increase, mainly due to increasing drug costs but also due to increasing surgery and hospitalization. Women had higher costs for surgery, all total joint replacements in hip and knee, except one, were performed in women. During the first 3 years, sick leave decreased, but was offset by a similar increase in disability pensions. Over the following years, sick leave decreased further, but disability pensions increased even more, leading to increasing total indirect costs every year. After initial improvement in EQ-5D, scores slowly deteriorated again. Patients, prescribed biologics, had higher direct costs before prescription, compared to non-users. Apart from surgery, higher costs were maintained after instituting biologics and to some extent, even increased. Conclusions Despite access to biologic drugs, costs continued to increase and drug costs were not offset by reduction in other costs. Effects of biologics must, however, be evaluated over longer time frames, comparing health care utilization and working ability, before and after introduction of biologics. Comparisons with the general population must also be taken into account, since health care utilizat