What the US Can Learn from Germany When it Comes to Reducing Rheumatoid Arthritis Treatment Costs

The overall cost of rheumatoid arthritis treatment has dropped over the past decade in Germany. Researchers there say several factors are driving the trend.

Increases in rheumatoid arthritis (RA) treatment costs over the past decade was linked to lower hospitalization rates, better functional status, lower incidence of work disability, and offset a large portion of increased drug costs, according to an analysis published in the Annals of the Rheumatic Diseases.

Researchers from various hospitals in Germany analyzed expense data from about 3,400 RA patients between 2002 and 2011 in order to compare the direct cost incurred by patients at working age (defined as ages 18 to 64 years) to patients of retirement age (65 years or older). There was no difference in disease activity between the older and younger patient groups. The cost data was calculated using a combination of fixed prices and annually updated cost factors. The researchers tabulated indirect costs using the human capital and the friction cost approaches.

In 2002, the proportion of gainfully employed patients was about 39 percent and rose to 53 percent in 2011. Patients on disability pension decreased from 24.5 percent to 20.6 percent over the study period. The researchers noted that even though there was a rising participation in the workforce, the proportion of patients with periods of sick leave in the previous 12 months remained stable — about a third of the participants gainfully employed saw decreases of 60 days to 47 days during the study period.

The researchers found a “considerable” increase in direct costs. First, in patients of working age, the increase was from €4914 to €8206 (about $5,400 to $9,000). For RA patients of retirement age or older, costs rose from €4100 to €6221 (about $4,500 to $6,800). These increases were attributed by the researchers to rising costs of prescription biologic agents — in patients aged 18 to 64 years, cost rose from 5.6 percent to 31.2 percent and for the older subset of patients costs increased from 2.8 percent to 19.2 percent.

However, the researchers also found decreases in inpatient treatment expenses (€299 [$329] or for a younger patient, and €429[$475] for a retired patient) and indirect costs due to sick leave and disability. The total growth of cost for the younger subset of patients was €2437 to €2981 (about $2,600 to $3,300), while for retirement aged patients, it was about €2121 (about $2,300).

“There was a continuous increase in the average annual costs for patients with RA treated by German rheumatologists between 2002 and 2011, driven by the growing use of biologic agents,” the authors concluded. “However, the increase was partly offset by decreasing costs for inpatient treatment, sick leave and work disability. Improvements in the employment situation seen in our data were similar to the population trend. The data also show that the rise in drug costs driven by biologic agents has been at a plateau since 2009.”