Direct costs of rheumatoid arthritis multidisciplinary care in Ireland

Chronic diseases are at epidemic proportions and continuing to increase in both incidence and prevalence globally. Therefore, there is a growing need to assess and improve on the value currently provided within chronic care pathways. Examining a chronic disease, Rheumatoid Arthritis (RA), this study aimed to assess the cost associated with RA in primary and secondary care within the Health Service Executive in Ireland. Following mapping of the care pathway, patient vignettes based on exemplar RA patient types were used to conduct semi-structed interviews with every member of the primary (N = 21) and secondary care (N = 13) RA pathway. Overall cost of each patient type was calculated using time-driven activity-based costing along with medication and clinic running costs. Treating newly diagnosed RA patients costs second highest in primary (€337.39/year) and highest in secondary care (€922.32/year). While patients with advanced RA were most expensive to treat in primary (€469.18/year) and least costly in secondary care (€615.70/year). In primary care occupational therapists were the most expensive allied health care professionals (HCPs) at €1.19/min, followed by physiotherapists at €1.17/min. GP secretaries were the least costly at €0.30/min. In secondary care, consultant rheumatologists and phlebotomists were most and least costly respectively at €3.10 and €0.60/min/patient. Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) cost significantly more (€8718.98/year) than Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) (€120.87/year). In terms of personnel cost newly diagnosed patients and patients with advanced RA are expensive to treat as these require more time with the HCPs. Being referred to departments outside of rheumatology such as orthopaedics, advanced RA patients cost less in secondary care. The difference between whether a patient was on a csDMARD or bDMARD had the biggest influence on total, overall costs amongst the RA patient. KEY MESSAGES: • The study provides a breakdown of costs of RA multidisciplinary care in Ireland, facilitating understanding cost drivers and potential areas for cost-savings. • The study advances the understanding of RA management in HSE Ireland.