About 90% of patients are diagnosed with rheumatoid arthritis in an outpatient setting, while the 10% diagnosed in an emergency department or as inpatients incur significantly higher health care costs.
Early diagnosis of rheumatoid arthritis (RA) can help patients and insurers avoid thousands of dollars in medical bills, according to a new analysis of insurance claims.
RA is a serious inflammatory disorder, but it can present with relatively subtle symptoms, such as fatigue, stiffness, and swelling. A lack of awareness of such symptoms by patients and providers can often lead to delayed diagnoses.
In a new paper presented at the Academy of Managed Care Pharmacy’s 2021 virtual meeting, corresponding author Kathryn Johnson, PharmD, of CVS Health, and colleagues presented their findings from an analysis of commercial and Medicare claims for patients who were diagnosed early versus those diagnosed late.
To distinguish between the stages, Johnson and colleagues used a proxy of diagnosis location. Patients who were diagnosed during a regular outpatient visit were considered early treatment initiators. Those diagnosed in an emergency department or inpatient setting were considered late diagnoses, since their diagnosis seemingly did not come until their symptoms were severe enough to warrant care in a hospital.
The authors used a 2019 dataset of 42,350 patients from a large commercial and Medicare health plan. Two-thirds (69.3%) of patients in the study were female, and the patients had an average age of 59.4. To qualify as a newly diagnosed patient, members had to be without an RA claim for at least 6 months prior to the initial RA claim that included the diagnosis. The investigators then examined the total cost of care of those patients for the 6 months prior to diagnosis and the 6 months following diagnosis.
Overall, the analysis showed that the vast majority of patients (90%) were diagnosed outside of the emergency department or inpatient setting. The remaining 10% had significantly higher spending in the year of their diagnosis. Patients on the commercial health plan spent an average of $4055 more over the course of the year compared with patients diagnosed outside of the hospital setting.
The excess costs for Medicare patients were smaller, though still significant, at $1670 more than peers diagnosed in an outpatient setting. While the overall cost of care for those patients included everything from direct care to pharmacy bills and lab work, the major driver of the increased spending was inpatient and/or emergency room bills, the data showed.
Yet, when the authors dug deeper into the numbers, they noticed a distinct trend—most of the excess per-member per-year cost associated with late diagnosis came in the 6 months prior to diagnosis. In the 6 months following diagnosis, the cost of care for patients who had been diagnosed early and those who had been diagnosed late had no statistically significant difference.
Johnson and colleagues said the data showed it is much more cost effective to diagnose patients in an office setting. “A late RA diagnosis was associated with a significantly higher total cost of care, compared to a timely RA diagnosis, for both commercial and Medicare patients,” they concluded.
The investigators said future studies should try to find better ways to identify and predict patients at risk of developing RA, which may result in fewer delayed diagnoses and lower costs of care.
Johnson K, Sawicki C, Sotelo C, et al. Medical savings of timely rheumatoid arthritis diagnoses. Presented at: Academy of Managed Care Pharmacy 2021: April 12-16, 2021. Poster M12.