The Economic Cost [1] section of this report uses the Medical Expenditures Panel Survey (MEPS), a standard source of cost of illness estimates, to estimate the total direct and indirect costs of musculoskeletal conditions and selected categories of musculoskeletal conditions, as well as the incremental direct and indirect costs specifically attributable to the selected category. Total costs are all costs for a patient regardless of the condition responsible; incremental costs are those costs attributed to a specified condition.
There are several important points to remember here. First, for arthritis and other rheumatic conditions, MEPS requires the use of selected three-digit ICD-9-CM codes, using the three- and four-digit NADW AORC ICD-9-CM codes [2] to create a similar category called “arthritis and joint pain.” This approach provides the best available estimates of the costs of AORC. Additionally, costs estimates are per person and reported as mean per-person costs. To arrive at the estimated aggregate cost, the mean per-person cost is multiplied by the number of people affected, resulting in a total cost for conditions in the United States.
MEPS provides estimates of actual medical expenditures, meaning money changing hands, rather than medical charges, which are based on what is originally billed but rarely paid in full. Thus, the term direct costs as used here reflects actual medical expenditures.
For total medical expenditures, mean per-person expenditures for arthritis and joint pain increased from an average of $6,393 in the years 1996 to 1998 to an average of $9,556 from 2009 to 2011 in 2011 dollars. For incremental medical expenditures, mean per-person expenditures for arthritis and joint pain increased from an average of $654 in the years 1996 to 1998 to an average of $1,909 in 2009 to 2011 in 2011 dollars. The change in total mean expenditures was 50%, while incremental mean expenditures rose by 192%. (Reference Table 10.6 PDF [3] CSV [4])
Mean per person direct costs include ambulatory care, inpatient care, prescriptions, and other health care costs. In 2011, ambulatory care and inpatient care each accounted for about a third of per person direct costs, with prescriptions accounting for another 25%. Over the past 15 years, prescription costs have seen the greatest change, rising nearly 60% per person in that time. Both inpatient and other health care costs went down by 20% and 23%, respectively. (Reference Table 10.4 PDF [5] CSV [6])
Total aggregate medical expenditures for people treated for all causes, including a diagnosis of arthritis and joint pain, in the United States increased from $185.2 billion in 1996 to 1998 to $580.9 billion in 2011 dollars, on average, for the years 2009 to 2011. Aggregate medical expenditures specifically attributed to arthritis and joint pain (incremental costs) in the United States increased from $18.9 billion in 1996 to 1998 to $116.1 billion in 2011 dollars, on average, for the years 2009 to 2011. While the increase over the 15-year period for total aggregate costs was more than 200%, the increase for incremental aggregate costs was greater than 500%. (Reference Table 10.6 PDF [3] CSV [4])
Mean and aggregate total and incremental direct and indirect costs for two types of arthritis using the annual average for years 2008 to 2011 MEPS data are calculated.
For total medical expenditures, mean per-person expenditures for osteoarthritis and allied disorders were $11,029 average for the years 2008 to 2011. Aggregate medical expenditures for the estimated 30.8 million persons with osteoarthritis and allied disorders in the United States averaged $340 billion in each of the years 2008 to 2011.
For incremental medical expenditures, mean per-person expenditures for osteoarthritis and allied disorders were $2,017 on average for the years 2008 to 2011. Aggregate incremental medical expenditures for the United States for osteoarthritis and allied disorders were $62.1 billion in each of the years 2008 to 2011. (Reference Table 10.13 PDF [7] CSV [8]).
For total medical expenditures, mean per-person expenditures for rheumatoid arthritis averaged $17,010 for the years 2008 to 2011. Aggregate medical expenditures for the estimated 1.04 million people with rheumatoid arthritis in the United States averaged $17.8 billion in each of the years 2008 to 2011.
For incremental medical expenditures, mean per person expenditures for rheumatoid arthritis averaged $6,428 for the years 2008 to 2011. Aggregate medical expenditures for the United States for rheumatoid averaged $6.7 billion in each of the years 2008 to 2011. (Reference Table 10.13 PDF [7] CSV [8])
Indirect costs as used in this report reflects estimates of earnings losses for people with a work history who are unable to work because of a medical condition. It does not reflect supplemental measures such as reduced productivity, worker replacement, or early retirement due to medical conditions.
Indirect costs are not estimated for the broad category of arthritis and joint pain.
For total earnings losses, mean per-person earnings losses attributed to osteoarthritis and allied disorders averaged $7,548 per year in 2008 to 2011. Aggregate earnings losses for the 16.1 million people in the workforce with osteoarthritis and allied disorders in the United States averaged $122 billion in each of the years 2008 to 2011.
For incremental medical expenditures, mean per-person earnings losses attributed to osteoarthritis and allied disorders averaged $4,951 per year in 2008 to 2011. Aggregate earnings losses for the United States due to osteoarthritis and allied disorders averaged $80 billion in each of the years 2008 to 2011.
Combining direct and indirect costs for osteoarthritis and allied disorders sums to total average costs of $461 billion, with incremental costs of $142 billion. (Reference Table 10.13 PDF [7] CSV [8])
For total earnings losses, mean per-person earnings losses attributed to rheumatoid arthritis averaged $13,886 per year in 2008 to 2011. Aggregate earnings losses for the estimated 900,000 persons in the workforce with rheumatoid arthritis in the United States averaged $12.3 billion per year in 2008 to 2011.
For incremental medical expenditures, mean per-person earnings losses attributed to rheumatoid arthritis averaged $8,684 per year in 2008 to 2011. Aggregate earnings losses for the United States due to rheumatoid arthritis averaged $7.7 billion in each of the years from 2008 to 2011.
Combining direct and indirect costs for rheumatoid arthritis sums to total costs of $30 billion, with incremental costs of $14.4 billion. (Reference Table 10.13 PDF [7] CSV [8])
Links:
[1] https://bmus.latticegroup.com/2014-report/x/economic-cost
[2] https://bmus.latticegroup.com/2014-report/iik0/icd-9-cm-codes-arthritis-and-other-rheumatic-conditions
[3] https://bmus.latticegroup.com/docs/T10007.6.pdf
[4] https://bmus.latticegroup.com/docs/T10007.6.csv
[5] https://bmus.latticegroup.com/docs/T10005.4.pdf
[6] https://bmus.latticegroup.com/docs/T10005.4.csv
[7] https://bmus.latticegroup.com/docs/T10014.13.pdf
[8] https://bmus.latticegroup.com/docs/T10014.13.csv