Research Article: Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment?

Date Published: February 2, 2017

Publisher: Public Library of Science

Author(s): Annelieke Pasma, Charlotte Schenk, Reinier Timman, Adriaan van ‘t Spijker, Cathelijne Appels, Willemijn H. van der Laan, Bart van den Bemt, Robert Goekoop, Johanna M. W. Hazes, Jan J. V. Busschbach, Jessica Myers Franklin.


Non-adherence to disease-modifying antirheumatic drugs (DMARDs) is suspected to relate to health care costs. In this study we investigated this relation in the first year of treatment.

In a multi-center cohort study with a one year follow up, non-adherence was continuously measured using electronic monitored medication jars. Non-adherence was defined as the number of days with a negative difference between expected and observed opening of the container. Cost measurement focused on hospital costs in the first year: consultations, emergency room visits, hospitalization, medical procedures, imaging modalities, medication costs, and laboratory tests. Cost volumes were registered from patient medical files. We applied multivariate regression analyses for the association between non-adherence and costs, and other variables (age, sex, center, baseline disease activity, diagnosis, socioeconomic status, anxiety and depression) and costs.

Of the 275 invited patients, 206 were willing to participate. 74.2% had rheumatoid arthritis, 20.9% had psoriatic arthritis and 4.9% undifferentiated arthritis. 23.7% of the patients were more than 20% non-adherent over the follow-up period. Mean costs are € 2117.25 (SD € 3020.32). Non-adherence was positively related to costs in addition to baseline anxiety.

Non-adherence is associated with health care costs in the first year of treatment for arthritis. This suggests that improving adherence is not only associated with better outcome, but also with savings.

Partial Text

Reviews have shown that in rheumatoid arthritis (RA), 49% to 99% of patients are adherent, depending on the measurement method of adherence [1]. Up till now, it is unclear what the actual impact of non-adherence to disease-modifying antirheumatic drugs (DMARDs) is to direct health care expenditures. Non-adherence to DMARDs is suspected to increase health care costs [2]. The aim of this study is 1) to examine the magnitude of the health care costs for inflammatory arthritis in the first year after diagnosis and 2) to determine whether non-adherence to DMARDs has an impact on health care costs.

This is the first study to find evidence that non-adherence is associated with hospital health care costs in the first year of treatment of arthritis. In addition to non-adherence, baseline symptoms of anxiety are associated to hospital health care costs.




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