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Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12


  1. Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpaşa Faculty of Medicine, Turkey.
  2. Department of Rheumatology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey.
  3. Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
  4. Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine, Istanbul, Turkey.
  5. Department of Internal Medicine, Hitit University Faculty of Medicine, Çorum; and Rheumatology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey.
  6. Division of Rheumatology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey.
  7. Division of Rheumatology, Department of Internal Medicine, Çukurova University Faculty of Medicine, Balcalı Hospital, Adana, Turkey.
  8. Department of Rheumatology, Gülhane Military Medical Academy, Ankara, Turkey.
  9. Department of Internal Medicine, Akdeniz University Faculty of Medicine, Antalya, Turkey.
  10. Medical Department, Pfizer Pharmaceuticals, Istanbul, Turkey.
  11. Department of Health Economics, Pfizer Pharmaceuticals, Istanbul, Turkey.
  12. Division of Rheumatology and Immunology, Department of Internal Medicine, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey.

2016 Vol.34, N°6
PI 1033, PF 1037
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PMID: 27749224 [PubMed]

Received: 11/01/2016
Accepted : 26/05/2016
In Press: 18/09/2016
Published: 28/11/2016


To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients.
In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs.
The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9.4±7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire-Disability Index (5.08±2.34 and 1.08±0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7±9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was € 4,954 (median, € 1,805), whereas the mean annual indirect cost was € 2,802 (median, € 608). Pharmacy costs accounted for the highest expenditure (mean, € 2,777; median, € 791), followed by the RA-related consultations and expenses (mean, € 1,600; median, € 696).
RA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.

Rheumatology Article