Healthcare utilization in rheumatic diseases

Rheumatoid arthritis (RA), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA) and axial spondyloarthritis (AxSpA; including ankylosing spondylitis) are inflammatory rheumatic diseases contributing to a substantial burden on both the patient and society. During the past couple of decades, active treatment strategies and pharmacological advancements have altered their cost structures, with scarce data existing on modern cohorts. Particularly for JIA in adulthood, the cost outcomes and clinical outcomes remain poorly documented. For these four rheumatic diseases, we set out to explore the health service-related costs, with emphasis on both costs of the index rheumatic disease and the costs of comorbidities. We investigated unmet needs by identifying disease-related factors attributable to distinct healthcare utilization patterns. We linked two population-based databases: a longitudinal clinical dataset with high diagnostic validity from the Jyväskylä Central Hospital rheumatology unit, and administrative data covering all public healthcare in the area. Collection of the clinical data took place between May 2007 and March 2016, and health service-related costs in euros (€) were available for fiscal year 2014. We studied the clinical outcomes in 218 adult JIA patients, with health service-related costs available for 119 adult patients with JIA, 213 with PsA, 1086 with RA, and 277 with AxSpA. We compared their cost distributions and high healthcare utilization patterns. Despite being heterogeneous, particularly regarding age, JIA, RA, PsA, and AxSpA shared similar patterns of healthcare resource utilization, both in terms of costs incurred by the rheumatic disease and by comorbidities. The majority of patients are doing overall well both in terms of patient-reported outcomes and health service-related costs, reflecting the effects of modern anti-rheumatic treatment. However, a tenth was recognizable as high healthcare utilizers (for JIA, 15%). Particularly pain, fatigue and disability, but also comorbidity and disease activity emerged as key factors affecting healthcare resource utilization. For all diseases, comorbidities accounted for two thirds of the total costs. This study supports the existing evidence that active treatment of rheumatic diseases has entailed good outcomes and low healthcare resource utilization for the majority. Particularly chronic pain, fatigue, and disability seem to be important areas needing attention in treatment of rheumatic diseases.