Direct medical costs and their predictors in the EMAR-II cohort: "Variability in the management of rheumatoid arthritis and spondyloarthritis in Spain".
OBJECTIVE
To analyze the resource utilization in rheumatoid arthritis (RA) patients and predictive factors in and patients treated with biological drugs and biologic-naïve.


METHODS
A cross-sectional study was performed in a sample including all regions and hospitals throughout the country. Sociodemographic data, disease activity parameters and treatment data were obtained. Resource utilization for two years of study was recorded and we made costs imputation. Correlation analyzes were performed on all RA patients and those treated with biological and biological naïve, to estimate the differences in resource utilization. Factors associated with increased resources utilization (costs) attending to treatment was analyzed by linear regression models.


RESULTS
We included 1,095 RA patients, 26% male, mean age of 62±14 years. Mean of direct medical costs per patient was €24,291±€45,382. Excluding biological drugs, the average cost per patient was €3,742±€3,711. After adjustment, factors associated with direct medical costs for all RA patients were biologic drugs (P=.02) and disease activity (P=.004). In the biologic-naïve group, the predictor of direct medical costs was comorbidity (P<.001). In the biologic treatment group predictors were follow-up length of the disease (P=.04), age (P=.02) and disease activity (P=.007).


CONCLUSIONS
Our data show a remarkable economic impact of RA. It is important to identify and estimate the economic impact of the disease, compare data from other geographic samples and to develop improvement strategies to reduce these costs and increase the quality of care.
Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, España; Universidad Camilo José Cela, Madrid, España. Electronic address: lleon.hcsc@salud.madrid.org.
Leticia
L
Leon
Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, España.
Lydia
L
Abasolo
Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, España.
Benjamin
B
Fernandez-Gutierrez
Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, España.
Juan Angel
JA
Jover
Agencia Española de Medicamentos y Productos Sanitarios, Madrid, España.
Cesar
C
Hernandez-Garcia
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D001685:Biological Factors / Q000191:economics* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013030:Spain; D025241:Spondylarthritis / Q000188:drug therapy* / Q000191:economics
D001685:Biological Factors
Artritis reumatoide; Cohorte nacional; Cost; Coste; Economic impact; Impacto económico; National cohort; Rheumatoid arthritis