REPEAT/Rheumatoid Arthritis Causes Increased Complications and Health Care Costs in Inpatient and Outpatient Settings.

Business Editors & Health/Medical Writers

REPEATING...

PHILADELPHIA--(BW HealthWire)--Oct. 29, 2000

Rheumatoid arthritis (RA) patients seek outpatient care for symptoms unrelated to the musculoskeletal problems of their disease one-third of the time and face significantly longer hospital stays and more costly charges from complications and joint replacements, according to two studies from researchers at Zynx Health Inc., a subsidiary of Cedars-Sinai Health System, presented this week at the American College of Rheumatology (ACR) annual meeting.

In the first study, patients with RA sought care for symptoms unrelated to musculoskeletal complaints 36 percent of the time. While musculoskeletal system symptoms ranked first among reasons for visits for both RA and osteoarthritis (OA) patients (64.5 percent and 68.8 percent of visits), RA patients were significantly more likely to want help for general symptoms such as fatigue (14.1 percent RA and 9.2 percent OA, p less than 0.05), digestive system symptoms (5.1 percent RA and 3.1 percent OA) and skin, nail or hair problems (2.6 percent RA and 1.2 percent OA, p less than 0.01). Data from the National Ambulatory Medical Care Survey was analyzed to determine stated reasons for visits by 1,171 RA patients, 4,709 OA patients and 270,058 non-arthritis patients for the years 1989 to 1998.

"Rheumatoid arthritis impacts more than just the joints. It also affects physical function and quality of life, and therefore is associated with non-arthritis related health care utilization," said co-investigator Joshua J. Ofman, M.D., M.S.H.S., from Cedars-Sinai. "We need to quantify the hidden aspects of health care utilization by these patients in order to better understand the quality of life impact and estimate the overall clinical and economic burden of a chronic disease like rheumatoid arthritis."

Current estimates of total direct costs for RA, based on a national community-based sample, are $4.76 billion, with physician visits accounting for approximately 30 percent and hospital admissions for nearly 70 percent. RA patients endure more than 9 million physician visits and more than 250,000 hospitalizations per year.

In a second study evaluating hospital discharge data for 92,026 RA patients in 13 states, researchers found hospital stays up to 141 percent longer for RA patients experiencing complications related to their disease, compared to cases without complications. Endocarditis, or inflammation of the heart lining, resulted in a 7.6-day longer stay than uncomplicated RA patients, who had a mean stay of 5.4 days. Sepsis, or blood infection, resulted in a 3.9-day longer stay than uncomplicated cases, and pneumonia a 1.8-day longer stay. Also, total charges were significantly more costly, up to 150 percent more, for complicated RA patients with endocarditic ($18,079 more), sepsis ($10,050 more), hip replacement ($9,827 more) and knee replacement ($9,159 more).

"Clearly, efforts to avoid disease progression resulting in joint replacement surgery and to prevent complications relating to the disease and its therapy is of benefit to patients as well as health care providers and payers," said Ofman. "New and investigational drug therapies for rheumatoid arthritis that are safe and focus on stopping the underlying disease process will be of great value."

Arthritis is the number one cause of disability in the United States, according to the Arthritis Foundation. Care costs for all forms of arthritis, which strikes 40 million Americans, tally an estimated $65 billion annually. Because disease progression may prevent arthritis sufferers from commuting or working a physically demanding job, as many as 50 percent of RA patients discontinue working after 10 years of onset, increasing to 90 percent with longer disease duration.

One out of every 100 Americans -- more than 2.1 million -- has RA, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). RA is an inflammation of the lining of the joints and other organs. Lasting for many years, RA can cause damage to bone, cartilage, tendons and ligaments to a degree that can cripple patients and restrict their ability to work, eat and care for themselves.

Zynx Health Incorporated, a subsidiary of the Cedars-Sinai Health System, is a leader in providing evidence-based solutions for improving the quality of care, reducing medical errors and controlling costs. Zynx Health Services Research performs outcomes research and health economic evaluations to assist clients in understanding the opportunities to improve care.

These studies were supported by Amgen (Nasdaq: AMGN), which is developing new and important therapies for RA. Amgen is a global biotechnology company that discovers, develops, manufactures and markets cost-effective human therapeutics based on advances in cellular and molecular biology.