Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Increase in Direct and Decrease in Indirect Costs of Rheumatoid Arthritis in Germany between 2002 and 2008.

Huscher2,  Dörte, Thiele2,  Katja, Pfaefflin2,  Andrea, Bischoff2,  Sascha, Alten4,  Rieke, von Hinueber3,  Ulrich, Schneider5,  Matthias K.

German Rheumatism Research Centre and Charité University Hospital, Berlin, Germany
German Rheumatism Research Centre, Berlin, Germany
Hildesheim, Germany
Schlosspark-Klinik KG, Department of Internal Medicine II, Rheumatology, Clinical Immunology Osteology, Berlin, Germany
University Hospital Düsseldorf, Duesseldorf, Germany


We recently observed a remarkable reduction in disease activity (DAS28) in patients with RA treated in German rheumatology during the past decade. The frequency and duration of hospitalization and sick leave decreased, whereas the work participation improved. We now analysed how these trends influenced direct and indirect costs.


We used data from the national database of the German Collaborative Arthritis Centres. An earlier cost analysis used data from the year 2002 which were less detailed than those available now. DMARD and glucocorticoid treatment has been collected now with dosages and exact duration which allows more accuracy in estimating figures of this major cost domain. For the years 2002–2004 these details were not available, and were imputed with median doses and median treatment durations from the following years. Non-pharmacological treatments were calculated for an assumed 9-months period per year. Cost components for hospitalization, sick leave and work disability were calculated by means of the German annual statistical yearbook. For indirect costs, both human capital approach (HCA) and friction cost approach (FCA; 58 days replacement period) were considered. Only those rheumatological units who had participated in all consecutive years were selected for analysis.


Drug treatment was the cost domain with the highest increase between 2002 and 2008 (Fig. 1). This increase was almost entirely caused by biologic therapies.

Comparing the main cost domains, these risen costs were accompanied by slightly decreasing costs for inpatient treatment and sick leave, and depending on the calculation approach a slight (FCA) or remarkable (HCA) decrease for permanent work disability (Fig. 2).

Accordingly, total costs showed a moderate increase (FCA) or remained almost stable (HCA) (Fig. 3).


We have seen a continuous increase of costs for drug treatment, mainly caused by the growing use of biologics. Depending on the health economic approach for the calculation of indirect costs, these risen direct costs were partially counterbalanced when using the friction cost approach, and were almost entirely compensated when using the human capital approach.

To cite this abstract, please use the following information:
Huscher, Dörte, Thiele, Katja, Pfaefflin, Andrea, Bischoff, Sascha, Alten, Rieke, von Hinueber, Ulrich, et al; Increase in Direct and Decrease in Indirect Costs of Rheumatoid Arthritis in Germany between 2002 and 2008. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :770
DOI: 10.1002/art.28538

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