Assessment of Direct, Indirect, and Intangible Costs of Rheumatoid Arthritis in Patients Receiving Biological Therapy in Morocco: Ecoram Study

OBJECTIVES: The present study aims to estimate the annual direct and indirect, and intangible costs of rheumatoid arthritis (RA) among patients with biological therapy in Morocco from the societal perspective and, to identify factors affecting the increase of these costs.

METHODS: This is a descriptive, observational and ambispective study, conducted in 110 patients with RA and under biotherapies from July 2019 until October 2020. The data collection was done by face-to-face interviews using a questionnaire. Indirect costs, including productivity losses and formal care, and intangible costs such as the cessation of physical and leisure activities, family care, and divorce or remaining single until menopause for women due to the disease were reported. Additional information was obtained from the patient’s files.

RESULTS: Patients had a mean age of 50.5 years, with 85% of women. Annual average total direct costs were $7,659 (range: $1,889.5 to $29,158.3), predominantly driven by medical expenses (98%). Notably, BDMADs accounted for 67%, costing $4,944.73. Significant factors linked to RA direct costs included marital status, number of children, working status, monthly household income, medical insurance type, disease duration, surgery history, and intake of DMARDs, NSAIDs, and antalgic drugs. For those experiencing salary loss, the annual average cost was $2,337.73 ± $1,649.80. Only 13 patients reported formal care expenses, averaging $421.84 ± $261.34. Statistical analysis revealed gender (p=0.028), disease duration (p=0.037), and cessation of sport/leisure activities (p=0.009) significantly impacting annual lost salary.

CONCLUSIONS: The overall burden of RA is substantial encompassing medical direct costs, productivity loss, caregiver costs, and notable intangible consequences like divorce and spinsterhood. These findings can inform strategies for enhanced governance of RA in Morocco and similar nations.