Abstract

Rheumatoid arthritis (RA) leads to progressive functional impairment and considerable economic burden. This study estimated the annual (12-month) cost per patient among patients with RA and its determinant factors. A descriptive cross-sectional economic study of RA patients who had been treated for at least one year at the outpatient clinic of a national referral hospital in Jakarta, Indonesia, and met the 2010 ACR–EULAR criteria. Data collected from January 2023 to December 2024 were obtained from medical and billing records for demographic characteristics, direct medical costs, and DAS28-based disease activity, whereas non-medical and indirect costs were collected through structured patient interviews. Costs were viewed from a societal perspective, direct medical costs were calculated from hospital tariffs and expressed in 2023 USD. Associations between total cost and its determinant factors were examined using bivariate analyses and multivariable linear regression. Disease-modifying antirheumatic drug (DMARD) utilization was summarized by frequency and annual cost. A total of 150 RA patients were analyzed, predominantly female (94.7%), and all covered by the National Health Insurance (NHI). The mean annual total cost per patient was USD 790, driven mainly by direct medical costs (mean USD 591), particularly medicines (mean USD 337). Total cost was significantly associated with age (p = 0.02) and disease activity (p < 0.01), both remaining significant in multivariable analysis. Higher disease activity was consistent with more frequent combination DMARD. In conclusion, the annual outpatient cost of RA increased with older age and higher disease activity, with medicines being the primary cost driver.

References

1. Martinec R, Pinjatela R, Balen D. Quality of Life in Patients with Rheumatoid Arthritis – a Preliminary Study. Acta Clin Croat. 2019; 58 (1): 157-166. DOI: 10.20471/acc.2019.58.01.20

2. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis. JAMA. 2018; 320 (13): 1360-1372. DOI: 10.1001/jama.2018.13103.

3. Ciofoaia EI, Pillarisetty A, Constantinescu F. Health disparities in rheumatoid arthritis. Ther Adv Musculoskelet Dis. 2022; 14: 1759720X221137127. DOI: 10.1177/1759720X221137127

4. Hidayat R, Suryana BPP, Wijaya LK, et al. Diagnosis dan Pengelolaan Artritis Reumatoid. Jakarta; Perhimpunan Reumatologi Indonesia; 2021.

5. Radu A-F, Bungau SG. Management of Rheumatoid Arthritis: An Overview. Cells. 2021; 10 (11): 2857. DOI: 10.3390/cells10112857

6. Su Q-Y, Yang L, Qi X-Y, et al. Global, regional, and national burdens of rheumatoid arthritis among people aged 60 years and older from 1990 to 2021: A trend analysis for the Global Burden of Disease Study 2021. Front Public Health. 2025; 13: 1527680. DOI: 10.3389/fpubh.2025.1527680.

7. Kalkan A, Hallert E, Bernfort L, et al. Costs of rheumatoid arthritis during the period 1990-2010: A register-based cost-of-illness study in Sweden. Rheumatol. 2014; 53 (1): 153–60. DOI: 10.1093/rheumatology/ket290.

8. Wang BCM, Hsu P-N, Furnback W, et al. Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database. Drugs Real World Outcomes. 2016; 3 (1): 107–114. DOI: 10.1007/s40801-016-0063-8.

9. Curtis JR, Fox KM, Xie F, et al. The Economic Benefit of Remission for Patients with Rheumatoid Arthritis. Rheumatol Ther. 2022; 9 (5): 1329–1345. DOI: 10.1007/s40744-022-00473-6.

10. van Riel PLCM, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016; 34 (5 Suppl 101): S40–44.

11. Hsieh P-H, Wu O, Geue C, et al. Economic burden of rheumatoid arthritis: A systematic review of literature in biologic era. Ann Rheum Dis. 2020; 79 (6): 771–777. DOI: 10.1136/annrheumdis-2019-216243.

12. Roodenrijs NMT, Welsing PMJ, Van Der Goes MC, et al. Healthcare utilization and economic burden of difficult-to-treat rheumatoid arthritis: A cost-of-illness study. Rheumatol. 2021; 60 (10): 4681–4690. DOI: 10.1093/rheumatology/keab078.

13. Jan SL, Shieh G. On Power and Sample Size Calculations of the Jonckheere–Terpstra and Tryon–Hettmansperger Tests for the Ordered Alternative Problem. J Probab Stat. 2025; 2025: 3450478. DOI: 10.1155/jpas/3450478.

14. Cole TJ, Altman DG. Statistics Notes: Percentage differences, symmetry, and natural logarithms. BMJ. 2017; 358: j3683. DOI: 10.1136/bmj.j3683.

15. Husereau D, Drummond M, Augustovski F, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. Value Health. 2022; 25 (1): 3–9. DOI: 10.1016/j.jval.2021.11.1351.

16. Huscher D, Mittendorf T, von Hinüber U. Evolution of cost structures in rheumatoid arthritis over the past decade. Ann Rheum Dis. 2015; 74: 738–745. DOI: 10.1136/annrheumdis-2013-204311.

17. Westhovens R, Boonen A, Verbruggen L. Healthcare consumption and direct costs of rheumatoid arthritis in Belgium. Clin Rheumatol. 2005; 24: 615–619. DOI: 10.1007/s10067-005-1119-4

18. Guillemin F, Durieux S, Daurès JP. Costs of rheumatoid arthritis in France: A multicenter study of 1109 patients managed by hospital-based rheumatologists. J Rheumatol. 2004; 31: 1297–1304.

19. Hamuryudan V, Direskeneli H, Ertenli I, et al. Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey. Clin Exp Rheumatol. 2016; 34 (6): 1033-1037.

20. Gebrye T, Mbada CE, Fatoye CT, et al. Economic Burden of Rheumatoid Arthritis in Low‐ and Middle‐Income Countries: Systematic Review and Meta‐Analysis. Arthritis Care Res. 2026; 78 (3): 325–336. DOI: 10.1002/acr.25627.

21. Klimeš J, Vocelka M, Šedová L, et al. Medical and Productivity Costs of Rheumatoid Arthritis in The Czech Republic: Cost-of-Illness Study Based on Disease Severity. Value Health Reg Issues. 2014; 4: 75–81. DOI: 10.1016/j.vhri.2014.07.004.

22. Zarrik H, Hassani AC, Slaoui M, et al. Direct Costs of Rheumatoid Arthritis among Patients with Biological Therapy in Morocco: ECORAM Study. Open Rheumatol J. 2025; 19: e18743129366062. DOI: 10.2174/0118743129366062250131091317.

23. Nagayoshi BA, Lourenção LG, Kobayase YNS, et al. Rheumatoid arthritis: Profile of patients and burden of caregivers. Revista Brasileira de Geriatria e Gerontologia. 2018; 21 (1): 44–52. DOI: 10.1590/1981-22562018021.170103.

24. Ten Klooster PM, Oude Voshaar MAH, Fakhouri W, et al. Long-term clinical, functional, and cost outcomes for early rheumatoid arthritis patients who did or did not achieve early remission in a real-world treat-to-target strategy. Clin Rheumatol. 2019; 38: 2727–2736. DOI: 10.1007/s10067-019-04600-7.

25. Bergman M, Zhou L, Patel P, et al. Healthcare Costs of Not Achieving Remission in Patients with Rheumatoid Arthritis in the United States: A Retrospective Cohort Study. Adv Ther. 2021; 38: 2558–2570. DOI: 10.1007/s12325-021-01730-w.

26. Ostor AJ, Sawant R, Qi CZ, et al. Value of Remission in Patients with Rheumatoid Arthritis: A Targeted Review. Adv Ther. 2022; 39: 75–93. DOI: 10.1007/s12325-021-01946-w.

27. Bali O, Singla S. Cost of Illness and Out-of-pocket Expenditure of Ankylosing Spondylitis and Rheumatoid Arthritis at a Tertiary Care Hospital in North India Using Conventional Disease-modifying Antirheumatic Drugs. Indian J Rheumatol. 2024; 19 (3): 170–183. DOI: 10.1177/09733698241239709.

28. Anggriani Y, Ramadaniati HU, Sarnianto P, et al. The Impact of Pharmaceutical Policies on Medicine Procurement Pricing in Indonesia Under the Implementation of Indonesia’s Social Health Insurance System. Value Health Reg Issues. 2020; 21: 1–8. DOI: 10.1016/j.vhri.2019.05.005.

29. Nagafusa T, Mizushima T, Suzuki M, et al. Comprehensive relationship between disease activity indices, mTSS, and mHAQ and physical function evaluation and QOL in females with rheumatoid arthritis. Sci Rep. 2023; 13: 21905. DOI: 10.1038/s41598-023-49380-y.

30. Orange DE, Blachere NE, DiCarlo EF, et al. Rheumatoid Arthritis Morning Stiffness Is Associated with Synovial Fibrin and Neutrophils. Arthritis Rheumatol. 2020; 72 (4): 557–564. DOI: 10.1002/art.41141.

31. Galloway J, Capron J-P, De Leonardis F, et al. The impact of disease severity and duration on cost, early retirement and ability to work in rheumatoid arthritis in Europe: An economic modelling study. Rheumatol Adv Pract. 2020; 4 (2): rkaa041. DOI: 10.1093/rap/rkaa041.

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