Abstract: Costs of Rheumatoid Arthritis in France: A Multicenter Study of 1109 Patients Managed by Hospital-Based Rheumatologists

Costs of Rheumatoid Arthritis in France: A Multicenter Study of 1109 Patients Managed by Hospital-Based Rheumatologists

FRANCIS GUILLEMIN, STEPHANIE DURIEUX, JEAN-PIERRE DAURÈS, ANTOINE LAFUMA, ALAIN SARAUX, JEAN SIBILIA, PIERRE BOURGEOIS, and JACQUES SANY

ABSTRACT.

Objective. The economic impact of rheumatoid arthritis (RA) is substantial, but most studies provide cost estimates specific to a US population. We performed a cost-of-illness analysis of patients with RA for French society.

Methods. A cross-sectional study among rheumatologists in 148 hospitals in France was conducted between November and December 2000. Data were collected on health resource consumption associated with RA (treatments, medical devices, physician visits, examinations, hospitalization, other health professional care) during the previous 12 months. Direct costs and social costs were evaluated for 1109 RA patients. The relation of costs to disease activity and severity was analyzed.

Results. The annual direct cost of RA per patient was over €4000. The costs due to hospitalizations represented around 60% of the costs. The major reason for hospitalization was acute care for RA in a rheumatic disease ward. Patients visited a physician an average of 13 times during the 12 months, 7.7 ± 8.6 visits to an office-based physician and 5.1 ± 4.4 visits to a hospital-based physician. Among them, 37% of patients were receiving at least one disability pension (16.7%) or sick-leave allowance (11.9%), with an estimated cost of €7328 per patient. The mean annual budget per patient was €2742. Medical and social costs increased in patients with severe disease (2 times), longer disease duration since diagnosis (more than double for patients with a history longer than 10 yrs vs patients with less than 2 yrs), active disease (1.4 times), and functional status (4 times more for American College of Rheumatology class IV than for class I).

Conclusion. Direct costs represented 59% of the total costs for patients with active RA and 57% for patients with severe RA. Social costs represented 41% of the total costs on average. (J Rheumatol 2004;31:1297-304)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
DIRECT COSTS
SOCIAL COSTS
DISEASE ACTIVITY
DISEASE SEVERITY
HOSPITALIZATION

From Ecole de Santé Publique, Vandoeuvre-les-Nancy; Unité de Rhumatologie, Hôpital St-Michel, Paris; UFR Médecine, IURC - Unité de Biostatistiques et d'Epidemiologie, Université de Montpellier, Montpellier; Cemka-Eval, Bourg la Reine; Service de Rhumatologie et Médecine Interne, CHU de Brest, Brest; Service de Rhumatologie, CHU Hautepierre, Strasbourg; Service de Rhumatologie, Hôpital de la Pitié-Salpêtrière, Paris; and Service d'Immuno-Rhumatologie Hôpital Lapeyronie, Montpellier, France.

Supported by the French Society of Rheumatology and by an unrestricted grant from Wyeth France. Independence was exercised over all aspects of study design and analysis.

F. Guillemin, MD, PhD, Faculty of Medicine, Ecole de Santé Publique; S. Durieux, MD, Unité de Rhumatologie, Hôpital St-Michel; J-P. Daurès, MD, PhD, UFR Médecine, IURC–Unité de Biostatistiques et d'Epidémiologie, Université de Montpellier; A. Lafuma, MD, Cemka-Eval; A. Saraux, MD, PhD, Service de Rhumatologie et Médecine Interne, CHU de Brest; J. Sibilia, MD, PhD, Service de Rhumatologie, CHU Hautepierre; P. Bourgeois, MD, PhD, Service de Rhumatologie, Hôpital de la Pitié-Salpêtrière; J. Sany, MD, PhD, Service d'Immuno-Rhumatologie, Hôpital Lapeyronie.

Address reprint requests to Dr. S. Durieux, Unité de Rhumatologie, Hôpital St-Michel, 33 rue Olivier de Serres, 75730 Paris Cedex 15, France.

Submitted August 7, 2003; revision accepted January 14, 2004.