Rheumatoid Modern Management is Better but More Costly Save

The mantra of rheumatologists worldwide is to treat rheumatoid arthritis (RA) earlier and more aggressively. While referral of early RA patients has improved, there is little data demonstrating that more aggressive treatment works or is cost effective.

Swedish researchers analyzed 463 patients with early RA who were studied in two different eras:  cohort enrolled 1996–98 (T1); and those enrolled between 2006–09 (T2). 

Disease activity was similar in both cohorts at inclusion. Significant improvements were seen during the first year in both cohorts, but were more pronounced in T2. Drug costs were higher in T2 than in T1 (EUR 689 vs. EUR 435). Drug costs (direct cost) increased over time, as did DMARD use at inclusion - 50% in T1 group versus >90% in the T2 group. Direct costs in T2 were higher than T1 (EUR 5716 vs EUR 4674), but T2 sick leave costs were lower than T1 (EUR 9055 vs. 5490).

The earlier and more aggressive treatment of RA with traditional DMARDs in T2 resulted in better outcomes compared to T1. Direct costs were higher in T2, partly offset by decreased sick leave, but overall total costs remained unchanged.