The survival of patients with rheumatoid arthritis (RA) increased after biologic treatment agents became available in 2003, but patients with RA treated with biologics may also face higher lifetime treatment costs compared with patients from the prebiologic era, according to a study in Arthritis & Rheumatology.

In this study, a group of researchers from Taiwan analyzed claims data from the National Health Insurance (NHI) of Taiwan recorded between 1999 and 2016. These data were validated using the Catastrophic Illnesses Registry to establish a study cohort of 29,352 new patients with RA. The objective of the study was to examine the cumulative incidence rate of RA between patients aged 16 to 84, lifetime expectancy, loss of lifetime expectancy, and lifetime healthcare costs for incident RA following 2003 when doctors began prescribing biologic agents.

The investigators estimated survival function of RA and generalized to the lifetime and simulated sex-, age-, and calendar year-matched referents from vital statistics for every case of RA and estimated their life expectancy. Mean monthly healthcare expenditures were multiplied by the survival rates and were used to calculate lifetime healthcare expenditures.


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Lifetime risks, expressed as the cumulative incidence rate, declined during the study period. Rates declined from 1.90% in females to 0.68% in 2016 in females and 0.59% to 0.31% in males. The estimated overall lifetime expectancy of RA was 26.3 years, whereas the loss of life expectancy was 4.97 years. The lifetime cost of RA was $72,953.

In this data set, females with RA appeared to survive 1 to 2 years longer than males with RA at the same age. This higher survival rate in females was associated with higher lifetime expenditures compared with males. The lifetime expectancy in Taiwan was also 6 to 7 years higher in females than in males. Overall, annual healthcare expenditures were similar between the 2 sexes.

A limitation of this study was the lack of data on quality of life and functional disability, which are 2 key factors indicative of disease burden of RA.

The researchers added that additional “studies are needed to evaluate the effects of biologics on functional disability, quality of life, and cost-effectiveness from a societal perspective that includes productivity loss and/or social services.”

Reference

Chiu YM, Lu YP, Lan JL, Chen DY, Wang JD. Lifetime risks, life expectancy and healthcare expenditures for rheumatoid arthritis-a nationwide cohort followed from 2003 to 2016. Arthritis Rheumatol. Published online December 8, 2020. doi:10.1002/art.41597