title: Analysis of direct medical and nonmedical costs for care of rheumatoid arthritis patients using the large cohort database, IORRA.
abstract: OBJECTIVE
  Our goal was to determine the annual direct medical and nonmedical costs for the care of patients with rheumatoid arthritis (RA) using data from a large cohort database in Japan.
  
  
  METHODS
  Direct medical costs [out of pocket to hospitals and pharmacies and for complementary and alternative medicine (CAM)] and nonmedical costs (caregiving, transportation, self-help devices, house modifications) were determined for RA patients who were participants in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) studies conducted in October 2007 and April 2008. Correlations between these costs and RA disease activity, disability level, and quality of life (QOL) were assessed.
  
  
  RESULTS
  Data were analyzed from 5,204 and 5,265 RA patients in October 2007 and April 2008, respectively. The annual direct medical costs were JPY132,000 [out of pocket to hospital (US$1 = JPY90 in 2007)], JPY84,000 (out of pocket to pharmacy), and JPY146,000 (CAM). Annual direct nonmedical costs were JPY105,000 (caregiving), JPY22,000 (transportation), JPY30,000 (self-help devices), and JPY188,000 (house modifications). Based on the utilization rate for each cost component, the annual medical and nonmedical costs for each RA patient were JPY262,136 and JPY61,441, respectively. Costs increased with increasing RA disease activity and disability level or worsening quality of life (QOL).
  
  
  CONCLUSIONS
  Based on the IORRA database, patients with RA bear heavy economic burdens that increase as the disease is exacerbated. The results also suggest that the increase in medical and nonmedical costs may be ameliorated by the proactive control of disease activity.
authors.affiliation: Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo 162-0054, Japan. e-tanaka@ior.twmu.ac.jp
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hoshi
authors.forename: Ataru
authors.initials: A
authors.lastname: Igarashi
authors.forename: Eisuke
authors.initials: E
authors.lastname: Inoue
authors.forename: Kumi
authors.initials: K
authors.lastname: Shidara
authors.forename: Naoki
authors.initials: N
authors.lastname: Sugimoto
authors.forename: Eri
authors.initials: E
authors.lastname: Sato
authors.forename: Yohei
authors.initials: Y
authors.lastname: Seto
authors.forename: Ayako
authors.initials: A
authors.lastname: Nakajima
authors.forename: Shigeki
authors.initials: S
authors.lastname: Momohara
authors.forename: Atsuo
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Tsutani
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012219:Rheumatology / Q000191:economics*; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents