The burden of rheumatoid arthritis: facts and figures.

In the most recent comprehensive economic study in the United States, the cost of arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA), was $64.8 billion US in 1992. Of the total costs of these diseases, about half were due to expenditures for medical care (direct costs) and about half were due to lost wages (indirect costs). Studies of the cost of RA undercount the true costs of this illness. Overall, costing methods create a bias against illnesses that occur disproportionately among women. The bias arises because the women with these conditions have historically had much lower labor force participation rates than men, and because women earn lower wages than men for similar work. In addition, there are many effects of RA that cannot be easily priced in the marketplace, although they are vital to the person and family affected by this disease. New approaches to therapy, which include earlier and more aggressive intervention, new drugs, and combinations of drugs, appear necessary to provide adequate control of inflammation, so that the longterm damage of RA might be prevented and the considerable costs reduced. The incremental costs, side effects, and benefits of therapies, compared to the average costs of disease, become much more relevant in policy discussions and clinical decision making. The possible adverse effects and costs of treatment must be balanced against the adverse effects and underestimated costs of RA.