Long-term morbidity, mortality, and economics of rheumatoid arthritis.
OBJECTIVE
To estimate the morbidity, mortality, and lifetime costs of care for rheumatoid arthritis (RA).


METHODS
We developed a Markov model based on the Arthritis, Rheumatism, and Aging Medical Information System Post-Marketing Surveillance Program cohort, involving 4,258 consecutively enrolled RA patients who were followed up for 17,085 patient-years. Markov states of health were based on drug treatment and Health Assessment Questionnaire scores. Costs were based on resource utilization, and utilities were based on visual analog scale-based general health scores.


RESULTS
The cohort had a mean age of 57 years, 76.4% were women, and the mean duration of disease was 11.8 years. Compared with a life expectancy of 22.0 years for the general population, this cohort had a life expectancy of 18.6 years and 11.3 quality-adjusted life years. Lifetime direct medical care costs were estimated to be $93,296. Higher costs were associated with higher disability scores.


CONCLUSIONS
A Markov model can be used to estimate lifelong morbidity, mortality, and costs associated with RA, providing a context in which to consider the potential value of new therapies for the disease.
Wong
J B
JB
New England Medical Center, Boston, MA 02111, USA. jwong@lifespan.org
Ramey
D R
DR
Singh
G
G
D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics* / Q000401:mortality*; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009017:Morbidity; D017063:Outcome Assessment, Health Care / Q000191:economics; D011358:Product Surveillance, Postmarketing; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires
D018501:Antirheumatic Agents