Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment?
BACKGROUND
Non-adherence to disease-modifying antirheumatic drugs (DMARDs) is suspected to relate to health care costs. In this study we investigated this relation in the first year of treatment.


METHODS
In a multi-center cohort study with a one year follow up, non-adherence was continuously measured using electronic monitored medication jars. Non-adherence was defined as the number of days with a negative difference between expected and observed opening of the container. Cost measurement focused on hospital costs in the first year: consultations, emergency room visits, hospitalization, medical procedures, imaging modalities, medication costs, and laboratory tests. Cost volumes were registered from patient medical files. We applied multivariate regression analyses for the association between non-adherence and costs, and other variables (age, sex, center, baseline disease activity, diagnosis, socioeconomic status, anxiety and depression) and costs.


RESULTS
Of the 275 invited patients, 206 were willing to participate. 74.2% had rheumatoid arthritis, 20.9% had psoriatic arthritis and 4.9% undifferentiated arthritis. 23.7% of the patients were more than 20% non-adherent over the follow-up period. Mean costs are € 2117.25 (SD € 3020.32). Non-adherence was positively related to costs in addition to baseline anxiety.


CONCLUSIONS
Non-adherence is associated with health care costs in the first year of treatment for arthritis. This suggests that improving adherence is not only associated with better outcome, but also with savings.
Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.|Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Annelieke
A
Pasma
Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Charlotte
C
Schenk
Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Reinier
R
Timman
Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Adriaan
A
van 't Spijker
Department of Rheumatology, Amphia hospital, Breda, the Netherlands.
Cathelijne
C
Appels
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.
Willemijn H
WH
van der Laan
Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands.
Bart
B
van den Bemt
Department of Rheumatology, Haga hospital, the Hague, the Netherlands.
Robert
R
Goekoop
Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Johanna M W
JM
Hazes
Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Jan J V
JJ
Busschbach
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics*; D015331:Cohort Studies; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D013997:Time Factors
D018501:Antirheumatic Agents