Total Costs Attributable to Biologic DMARDs in Rheumatoid Arthritis

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physician spending
A systematic review analyzes the direct medical costs associated with the treatment of RA.

The total and disease-specific direct medical costs of treating rheumatoid arthritis (RA) is substantial, with the cost of RA care contributing to more than half of all direct medical costs for patients taking biologic disease modifying antirheumatic drugs (bDMARDs), according to a review published in Arthritis Care & Research.

Although not well studied, the cost of treating RA has increased with the approval of new medications such as bDMARDs. Using Medline, researchers conducted a systematic literature review with a meta-analysis of direct medical costs associated with RA care since the approval of the first bDMARD in the United States in 1999. After reviewing the abstracts for 541 citations, they identified 12 studies that met all of their inclusion criteria.

They found that the cost of direct medical care for a patient with RA in the United States was $12,509 and that the costs attributable to RA were $3725, or 30% of the total costs. Among patients taking bDMARDs, the total direct medical costs were $36,053 and the costs attributable to RA were $20,262, or 56% of the total.

Although bDMARD use had a larger incremental effect on RA-specific costs (444% increase) than on total direct medical costs (188% increase), these increments were below the total cost of bDMARDs themselves, indicating that the use of bDMARDs may be associated with either lower total non-drug direct medical costs or that patients who used bDMARDs may have fewer comorbid conditions.

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The studies included in this analysis did not include assessments of RA outcomes; however, these findings may be of value for future cost-effectiveness studies to further understand the benefits of treatment options available to patients with RA. The authors concluded that, “the direct medical costs of patients with RA are significant. Clearly, medication costs comprise a substantial portion of these costs, especially for patients using bDMARDs.”


Hresko A, Lin J, Solomon DH. Medical care costs associated with rheumatoid arthritis in the US: a systematic literature review and meta-analysis [published online January 5, 2018]. Arthritis Care Res. doi:10.1002/acr.23512