The annual direct health care expenditures per person with arthritis remained relatively stable over the years from 2008 to 2014, but the rise in proportion of the arthritis patients in the U.S. population led to billions more dollars being spent on this population, reported Amit D. Raval, PhD, and Ami Vyas, PhD, of the University of Rhode Island, Kingston.

The Medical Expenditure Panel Survey (MEPS) data was used to estimate health care expenditures among individuals aged 18 years and older with and without arthritis during 2008-2014. About one in five adults in the study had arthritis, which is in line with the Centers for Disease Control and Prevention’s estimates during this time period.

Aggregate expenditures for patients with arthritis rose from $584.8 billion in 2008 to $645 billion in 2014, accounting for about 4% of the U.S. gross domestic product in these years, the investigators reported in the Journal of Rheumatology . “The increase in aggregate unadjusted total direct health care expenditures was mainly driven through an increase in weighted population of individuals with arthritis,” which rose from 56.1 million adults with arthritis in 2008 to 65.1 million in 2014. Nonetheless, there was a “slowdown in the intensity of adjusted incremental expenditures and [out of pocket expenditures] specifically from 2013, which led to a huge decline in the aggregate direct healthcare expenditures in 2014.”

During this time period, there was an increase in the percentage of Hispanics, poor, obese, and individuals with activity limitations and mental health disorders among both those with and without arthritis. This is consistent with the study findings that incremental health care expenditures in persons with arthritis were largely driven by difference in age, health status, and chronic conditions, such as hypertension, hyperlipidemia, and heart disease, among those with and without arthritis, Dr. Raval and Dr. Vyas said.

Annual total health care expenditures in persons with arthritis fell from $10,424 in 2008 to $9,910 in 2014. The average annual total out-of-pocket expenditures in 2008 was $1,493, which was 14% of total health care expenditures that year; in 2014, this fell to $1,099. There were similar trends in persons without arthritis, Dr. Raval and Dr. Vyas reported.

The top three expenditure categories in 2008 were outpatient (32.6%), inpatient (29.0%), and prescription drug costs (24.7%); in 2014, these changed to outpatient (33.8%), prescription drug (26.8%), and inpatient costs (26.4%). There are a number of ways to explain these trends, the researchers said. It is likely that outpatient services, such as outpatient orthopedic surgeries, are becoming “a common management option for arthritis.” Also, outpatient medication services now may include administration of injectables such as biologics. There also were “relatively stable” inpatient expenditures from 2008 to 2013 and a decline in 2014. “Our findings are consistent with studies assessing the effect of the Affordable Care Act, such as introduction of the Hospital Readmission Reduction Program,” said Dr. Raval and Dr. Vyas.

SOURCE: Amit R et al. J Rheumatol. 2018 Jan 15. doi: 10.3899/jrheum.170368.


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