Bangkok, Thailand—Rheumatoid arthritis (RA) is seen as a “nonfatal” disease and attracts less public health interest in developing countries than diseases such as AIDS, cancer, and coronary heart disease. This may be a mistake in view of the extremely high societal costs of RA cases in Thailand, according to a new prospective cohort study published in the Journal of Rheumatology.1
Manathip Osiri, MD, and colleagues in the division of rheumatology, Chulalongkorn University, in Bangkok, Thailand, report that the average societal cost of RA in Bangkok was US$2682 or 41.4% of patients' average annual income. The average direct cost was US$2135 per patient per year, and the average indirect cost was $547 per patient per year.
RA: A significant economic burden to society
The new study was conducted before biologic therapies became available, but the researchers don't think their availability would affect direct costs, since few Thai patients are likely to have access to them. Indirect costs were lower in this study than in other studies in Western countries, but researchers speculate that this may be due to differences in patient characteristics and components of costs involved in indirect costs.
Seventy-three patients (46.2%) experienced at least one event of intangible losses such as separation/divorce, increased family member workload, lost social opportunities, and residential moves caused by their RA. The study also found that slightly more than 29% of RA patients had decreased earning ability. The researchers reported that poor physical function, joint deformity, and use of a high number of disease modifying anti-rheumatic drugs and steroids contributed to higher costs and the presence of intangible losses.
"RA consumes a significant proportion of patients' annual average incomes and poses a significant economic burden to society," Dr. Osiri writes. "Since RA mainly affects a working-age population, early and timely treatment of this disease can improve both the suffering and the economic productivity of patients in Thailand."
The researchers analyzed data on costs and intangible losses at regular intervals over a 1-year period among 158 RA patients from a tertiary care facility in Bangkok. They estimated the direct medical, direct nonmedical, indirect, and total costs according to patients' respective health insurance conditions and converted it to the relative value of US dollars in 2001.
"Unfortunately the burden of RA is not considered important or is even neglected in developing countries [because] RA is 'non-fatal' and cannot produce an immediate impact on society like 'fatal' diseases such as coronary heart disease, cancer, and AIDS," the authors conclude.
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"I think this is very important information because it indicates the extreme relative cost of RA in developing countries even when really expensive medicines are not available," said CIAOMed editor-in-chief Peter Lipsky, chief of the autoimmunity branch in the office of the clinical director at the National Institute of Arthritis and Musculoskeletal and Skin Diseases Intramural Research in Bethesda, Maryland.
"The relative impact of RA is probably similar or greater in other developing countries. Remember that Thailand is relatively well off," Dr. Lipsky said. "Rheumatologists everywhere can advocate more comprehensive health and disability insurance as well as the development of a network of support and care for persons with chronic disease. Indeed better medical education that promoted early diagnosis and intervention would also benefit patients with RA."
Reference
1. Osiri, M, Maetzel A, Tugwell P. The economic burden of rheumatoid arthritis in a developing nation: Results from a one-year prospective cohort study in Thailand. J Rheumatol. 2006; Dec 15; [Epub ahead of print].