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

Abstract

Background: The economic burden of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in India is significant. Aim: To estimate the cost of illness (COI) and out-of-pocket expenditure of AS and RA among patients on conventional disease-modifying antirheumatic drugs. Methodology: A retrospective, cross-sectional study on 87 participants using a prevalence-based, bottom-up approach and the human capital method was adopted to calculate the direct and indirect costs of RA and AS. Results: The average COI for patients with RA was estimated to be ₹51,741 person per year, whereas the COI for patients with AS was ₹41,379 per person per year (Consumer Price Index 2021: 134.44). Direct cost was the major contributor to COI constituting 65.21% [₹33,743] and 58.84% [₹24,348] of the total COI of RA and AS, respectively. Increasing disease severity, longer duration of illness and increasing impairment of daily activities were significantly associated with increasing COI of both RA and AS. The main expense towards annual direct costs per year in patients with RA was medication expenses, whereas for patients with AS, it was investigation expenses. Out-of-pocket spending was significant as nearly half (54.95%) of the direct expenditure on health for both RA [₹18,544] and AS (39.2%) [₹9,544] was borne by patients themselves. RA and AS caused catastrophic health expenditure in 14.92% and 6.67% of households, respectively. Indirect costs of RA and AS were ₹17,998 and ₹17,030, respectively. Indirect costs of RA and AS increased as productivity at work decreased. Average overall work productivity impairment and overall activity impairment reached close to 50% and was comparable for RA and AS. Conclusion: The economic burden of RA and AS is significant. There is an urgent need to prioritise policies and interventions for management of rheumatological conditions.