RESEARCH - Out-of-pocket expenses and their burden in patients with RA

November 8, 2009

Arthritis Rheum. 2009 Oct 29;61(11):1563-1570.

Out-of-pocket expenses and their burden in patients with rheumatoid arthritis.

Wolfe F, Michaud K.

University of Kansas School of Medicine, and National Data Bank for

Rheumatic Diseases, Wichita, Kansas.

OBJECTIVE: To describe and understand the burden of out-of-pocket

expenses in patients with rheumatoid arthritis (RA).

METHODS: We studied out-of-pocket expenses and their burden in 8,545

US patients with RA. We determined direct medical costs, out-of-pocket

expenses, the burden of out-of-pocket expenses, household income, and

measures of RA severity and outcome. In addition, patients were

classified into 3 groups based on the level of burden caused by

out-of-pocket expenses: no or limited problem (I am able to pay the

bills without much problem); moderate problem (paying the bills takes

away some money I need for other activities); and a great problem (I

can't purchase all of the medications or medical care that I need).

RESULTS: A total of 43.6% of patients reported problems paying medical

bills after insurance payments and 9.0% reported severe or great

problems. Problems with expenses were associated with measures of RA

severity, but also and particularly with lower household income and

absence of health insurance. The proportion of household income that

was consumed by out-of-pocket spending for the 3 groups was 2.4%,

7.2%, and 19.2%, respectively, and the percentage of patients meeting

the 185% poverty level for these groups was 12.3%, 24.4%, and 51.3%,

respectively.

CONCLUSION: The out-of-pocket burden is substantial, particularly in

those <65 years of age. Out-of-pocket expenses exert their severity

predominantly on those with the most severe RA who have the least

ability to pay. Household income is the primary determinant of

out-of-pocket burden, followed by RA severity, and type of health

insurance.

PMID: 19877107

Not an MD

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