title: Cost of illness in rheumatoid arthritis in Germany in 1997-98 and 2002: cost drivers and cost savings.
abstract: OBJECTIVE
  Comparison of overall RA-related costs and of relative contribution of single-cost domains before and after the introduction of TNF-blocking agents in Germany.
  
  
  METHODS
  Two cohorts of RA outpatients (ACR '87 criteria) with long-standing disease are assessed in terms of disease-related costs and cost composition (n = 106 patients in 1997-98 and n = 180 patients in 2002 with similar patient characteristics). Full-cost analyses are performed including direct disease-related costs (medical and non-medical) and productivity costs as collected by patient questionnaires. Absolute costs (€/patient/year) are compared and the impact of single-cost domains on overall costing in RA is estimated (relative proportions of cost components within samples).
  
  
  RESULTS
  Overall costs are comparable (1997-98: €4280; 2002: €3830; not significant). Differences can be observed in medication (1997-98: €550; 2002: €1580; P < 0.001) and hospitalization costs (1997-98: €1240; 2002: €500; P < 0.001). Productivity costs are significantly lower (€1480 vs €850; P < 0.05) in 2002. The impact of medication costs is outstanding in the 2002 sample (42 vs 12%), the proportion of hospitalization costs is substantially lower (29 vs 13%). Costs for DMARDs in 2002 are mostly driven by TNF blockers (37%). The number of DMARDs per patient is higher in 2002 as are costs for osteoporosis medication and gastroprotective treatment.
  
  
  CONCLUSIONS
  Although overall costs before and after the introduction of TNF blockers are comparable, the decrease in hospitalization and productivity costs is promising in terms of future long-term cost savings. The development of these aspects and of the increasing medication costs will have to be evaluated with longer time frames.
authors.affiliation: Division of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Kirchhoff
authors.forename: Jörg
authors.initials: J
authors.lastname: Ruof
authors.forename: Thomas
authors.initials: T
authors.lastname: Mittendorf
authors.forename: Markus
authors.initials: M
authors.lastname: Rihl
authors.forename: Michael
authors.initials: M
authors.lastname: Bernateck
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mau
authors.forename: Henning
authors.initials: H
authors.lastname: Zeidler
authors.forename: Reinhold E
authors.initials: RE
authors.lastname: Schmidt
authors.forename: Sonja
authors.initials: S
authors.lastname: Merkesdal
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D015331:Cohort Studies; D017046:Cost Savings / Q000706:statistics & numerical data*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004526:Efficiency; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha