Health economics

The economic burden of rheumatic diseases for society, various payers, and last but not least the individual patient has been increasingly recognized. In addition to the well-known impact of back pain and osteoarthritis, the upcoming new and expensive therapies have made this issue especially intriguing in the treatment of rheumatoid arthritis (RA). A mean international estimate of the total annual costs of RA, mainly consisting of direct resource consumption and indirect costs due to productivity losses relating to paid work, comes to about €5600. Other inflammatory rheumatologic diseases (ankylosing spondylitis, psoriatic arthritis, lupus erythematosus) generate similar costs. The implementation of expensive biological drugs in rheumatic care has also led to the pressing need to determine the relation of their costs and clinical outcome (e.g. quality-adjusted life-years, QALYs) in order to compare different treatment strategies in defined patient groups. In RA the health-economic evidence for the cost-effectiveness of biologicals is already quite substantial in terms of treatment of early and advanced RA, as last option treatment of patients refractory to TNF inhibitors. Their cost-effectiveness as first line treatment is less clear. All biologicals have proved their cost-effectiveness in various settings depending on patient selection. It has been clearly demonstrated that adherence to the current guidelines, including monitoring of their effectiveness. leads to cost-effective scenarios. In TNF-refractory RA, abatacept and rituximab have proved to be economically favourable strategies. Economic data on other inflammatory rheumatic entities is relatively sparse. Incomplete long-term and observational data are still the most prominent gaps in health-economic evidence relating to rheumatic disorders.