RA: How High Is the Toll?

Summary of Research

This retrospective, observational study with a cross-sectional design analyzed results from the Medical Expenditure Panel Survey (MEPS) from 2018 to 2020. MEPS is an annual, nationally representative survey involving families and individuals in the U.S. It includes data on their sociodemographic characteristics, medical conditions, health service use and expenditure.¹¹

The study included patients aged 18 years or older with self-reported RA or an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) code diagnosis of RA. The non-RA comparator group included all remaining individuals aged 18 or above. Annually, 4.27 million adults with RA were identified.

To assess the economic burden of RA, Huang et al. examined the aggregate expenditure associated with any healthcare services. This included the costs of “inpatient, outpatient, emergency department, prescription medication, dental, home health and other services (such as ambulance, equipment and glasses).”¹ Expenditure estimates included the actual amount paid by patients or payers as opposed to the cost of services received by providers, and adjustments were made to account for inflation.

Patients with RA were more likely to have a suboptimal quality of life than patients without RA.

The mean annual unadjusted healthcare expenditure for RA was $24,068 [95% confidence interval (CI) $20,627.49–27,508.25]—far higher than that of the non-RA group ($8,642.27 [95% CI $8,120.12–8,642.27]). Most of the healthcare expenditures for patients with RA were for prescription medications, the inpatient setting and office-based visits.

After adjusting for all covariates (e.g., sociodemographics and comorbidities), the total healthcare expenditure for RA was $3,382.97 [95% CI $1,816.50–4,949.44; P<0.0001] higher than that for non-RA patients. And in adjusted analyses, the average expenditures for prescription medication in RA were $2,319.15 (95% CI $1,408.39–3,229.90; P<0.001) higher than that for the non-RA group. No significant differences for other types of expenditures were identified in this study.

The humanistic burden of RA was measured via quality-of-life questionnaires, which included a physical component summary (PCS) and mental component summary (MCS). The health status variables activities of daily living (ADL) and instrumental ADL (IADL) were also considered as measures for autonomy and self-dependence.

The RA group was associated with lower PCS scores (mean 4.78 [95% CI 3.47–6.09]) and similarly lower MCS scores (mean -0.84 [95% CI -2.18–0.50]). Patients with RA also had increased odds of requesting ADL and IADL assistance (adjusted odds ratio 2.02 [95% CI 1.59–2.56] and 2.11 [95% CI 1.59–2.56] respectively).