Rheumatoid Arthritis Carries High Costs for Employers

Rheumatoid arthritis (RA) is a significant but potentially manageable contributor to employers' health costs, reports a study in the February Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

Led by Ronald J. Ozminkowski, Ph.D., of the Cornell University Institute for Health and Productivity Studies, the researchers assessed costs associated with RA in a sample of 8,502 workers at nine U.S. companies. Direct and indirect costs for workers with RA were compared with those of a group of workers without RA but matched for other characteristics.

Average annual medical costs were substantially higher for workers with RA—$4,244 higher than for workers without RA. (All costs were expressed in 2003 dollars.) Nearly all of the extra costs associated with RA were for direct medical care; indirect costs such as absenteeism or short-term disability were only slightly elevated for workers with RA.

Although not as common as other diseases incurring major health care costs, RA was still a major contributor to costs. Among affected patients, the extra costs associated with RA were second only to those of chronic kidney failure.

With adjustment for prevalence, RA was the fourth most expensive medical condition; only heart disease, hypertension, and depression carried higher costs on a per-worker basis. Rheumatoid arthritis cost employers an average of $111 per employee per year—a higher total than for conditions such as low back pain or asthma.

Rheumatoid arthritis is a chronic inflammatory disease that causes long-term damage to the joints, resulting in pain and disability. Women are affected approximately three times more often than men. Its occupational impact is increased because most patients affected with RA are in their prime working years—between the ages of 25 and 55.

Although there is no cure for RA, several treatments can help to control it. The results are best when RA is diagnosed promptly and treatment with disease-modifying drugs (such as methotrexate) is started as soon as possible—preferably within three months. Although these drugs are effective in controlling the inflammation that causes joint damage in RA, concern about side effects has limited their use.

"Employers should consider the long-term direct and indirect costs of RA in evaluating the potential cost and value of various medical plan designs relating to RA benefits," Dr. Ozminkowski and coauthors write. "Appropriate treatment of the early stages of RA may effectively reduce long-term disability costs and allow employees to continue to be productive members of the workforce." Employers should also recognize work-related factors that may increase the likelihood of worker disability, perhaps with the assistance of vocational counselors and other specialists experienced with RA and the workplace.

ACOEM, an international society of more than 5,000 occupational physicians and other healthcare professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.