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Was kostet die rheumatoide Arthritis den Erkrankten? „Out-of-Pocket“—Ausgaben im Frühstadium der Erkrankung

Out-of-pocket medical spending for care in patients with recent onset rheumatoid arthritis

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Zusammenfassung.

869 Patienten mit früher rheumatoider Arthritis (ACR-Kriterien, Krankheitsdauer <2 Jahre) wurden ein halbes Jahr nach Studieneintritt anhand einer Liste von 14 definierten Bereichen befragt, ob ihnen in den vergangenen 6 Monaten in den einzelnen Bereichen krankheitsbedingte Kosten entstanden sind und wie hoch die Kosten waren. Die Auswertung erfolgte pro Kostenbereich und als mittlere Summe bzw. Median aller Bereiche. 82% der Patienten entstanden Kosten als Zuzahlungen zu verordneten Medikamenten und 56% entstanden Kosten für zusätzlich gekaufte rezeptfreie Medikamente. Im Mittel gab jeder RA-Kranke 47 (±67) bzw. 45 (± 96) € pro Halbjahr dafür aus. Vergleichbare durchschnittliche Kosten entstanden durch die Inanspruchnahme von Maßnahmen der alternativen Medizin (47±250€), obwohl nur 14% der Patienten diese genutzt hatten.

Über alle Bereiche gerechnet hatten Patienten mit rheumatoider Arthritis pro Jahr durchschnittlich 628±566 € (Median 306 €, Interquartilbereich 66–334 €) für Medikamente und andere krankheitsbedingte Maßnahmen aus eigener Tasche zu zahlen. Die im Median entstandenen Kosten von 306 € entsprechen rund 2% des durchschnittlichen verfügbaren Jahreseinkommens in Deutschland. Je schwerer die Patienten erkrankt waren, desto höher waren die selbst zu zahlenden Kosten. Eine multivariate logistische Regressionsanalyse zeigte, dass Patienten mit starken gegenüber Patienten mit leichteren Funktionsbeeinträchtigungen (HAQ≥1,5 vs. HAQ <1,5) und Patienten mit schlechtem gegenüber gutem Gesundheitszustand (NRS 7–10 vs. NRS 0–3) ein rund 2,5-faches Risiko hatten, Kosten über 306 € pro Jahr zu haben (OR=2,6; KI 1,7–4,0 bzw. OR=2,4; KI 1,4–4,4). Auch starke Schmerzen verdoppelten die Wahrscheinlichkeit, zu den Patienten mit hohen Kosten zu gehören. Die niedrigste Wahrscheinlichkeit für überdurchschnittliche Kosten hatten arbeitslose gegenüber erwerbstätigen Patienten (OR=0,28; KI 0,1–0,6).

Summary.

We examined out-of-pocket medical expenditures (OoP) of 869 patients with recent onset rheumatoid arthritis (ACR criteria, disease duration <2 years) using data from a prospective observational cohort. Out-of-pocket costs were retrospectively assessed for a period of 6 months by a list of 14 cost domains. Of the patients, 82% had costs due to copayments for prescribed drugs and 56% for over-the-counter drugs. Within six months each patient spent an average of 47 (± 67) Euro as co-payment and 45 (± 96) Euro for over-the-counter drugs. A comparable sum was spent for complementary and alternative medicine (47±250 Euro), which was used by 14% of the patients. The mean total OoP expenditure caused by RA was 628 Euro p.a. (median 306, IQ 66–334 Euro). The median costs accounted for approximately 2% of the average disposable yearly income in Germany. Out-of-pocket spending increased with functional limitations, poor health condition and pain as well as with level of education. A multivariate logistical regression analysis showed that patients with these characteristics spent about twice as much as patients with mild disease or low educational level. The odds ratios for having more than 306 Euro OoP-costs p.a. were OR=2.6 (CI 1.7–4) for patients with severe vs. moderate functional disability (HAQ≥1.5 vs <1.5), OR=2.4 (CI 1.4–4.4) for patients in poor vs. good health condition (NRS 7–10 vs 0–3), and OR=2.1 for patients with severe vs. mild pain (CI 1.4–3.3). The level of OoP spending also varied by employment status (OR=0.28; CI 0.1–0.6 for jobless vs employed patients). Despite almost universal insurance coverage in Germany, patients with rheumatoid arthritis were exposed to substantial OoP expenditures. As policymakers discuss cost sharing and design of benefit packages to contain health spending, it is important to consider the expenditures that persons with chronic conditions like rheumatoid arthritis already have.

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  1. Deutsches Rheuma-Forschungszentrum Berlin, Forschungsbereich Epidemiologie, Schumannstraße 21/22, 10117, Berlin, Germany

    G. Westhoff, J. Listing & A. Zink

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  1. G. Westhoff
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  2. J. Listing
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  3. A. Zink
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Westhoff, G., Listing, J. & Zink, A. Was kostet die rheumatoide Arthritis den Erkrankten? „Out-of-Pocket“—Ausgaben im Frühstadium der Erkrankung. Z Rheumatol 63, 414–424 (2004). https://doi.org/10.1007/s00393-004-0650-z

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  • DOI: https://doi.org/10.1007/s00393-004-0650-z

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