1. Economics of rheumatology
Dr Chandrashekara S
ChanRe RICR
Banaglore

2. Disclaimers I am not an economist or a commerce graduate.
There are some events and objects cannot be accounted by economics and in money.
These are based on available literature and the practice of analysis of economic burden and impact.

3. Aspects discussed Policy making- in patient care
Single therapeutic intervention
Impact in health budgeting
Self financing
State funding
Insurance funding
Hospital budgeting
Estimation of turnover of a dept
Valuing rheumatologist
Individual Patients perspective
Affordability
Need to spend
Organizing fund
Professional perspective

4. Single therapeutic intervention
Involve cost to benefit ratio of a intervention
How much a new therapeutic modality either reduces or adjusts to the overall cost incurred to benefit obtained
Single therapeutic intervention

5. Celcoxib vs Nemusulide in pain relief
How does it work
Single point analysis= calculating the direct cost incurred (both are equal in case of NSAID, they are wide in second case).
But if quantified against the adverse event and the cost incurred in handling it and the cost incurred if occur at the expected frequency the differances emerges.
Then it need a technical evaluation which in long term in majority can be safely administered
Celcoxib vs Nemusulide in pain relief
Mtx vs Newer biologic in disease modifying

6. Markov model
a cohort of patients is followed over time as they move among predefined states of health in a computer simulation of the natural history of their disease.
By tracking the proportion of the cohort alive during each time interval and their resource utilization, the computer simulation estimated lifetime costs and life expectancy or quality- adjusted life expectancy for the cohort.
Health states were chosen to capture differences in treatment as well as cost and quality of life for the cohort.
The Markov model defined 17 states of health based on pairwise combinations of 4 treatments and 4 disability categories, as well as deceased.
Wong, John B., Dena R. Ramey, and Gurkirpal Singh. "Long‐term morbidity, mortality, and economics of rheumatoid arthritis." Arthritis & Rheumatism (2001):

7. Gabriel, S. E. , P. Tugwell, and M. Drummond
Gabriel, S. E., P. Tugwell, and M. Drummond. "Progress towards an OMERACT-ILAR guideline for economic evaluations in rheumatology." Annals of the rheumatic diseases 61.4 (2002):

8. Policy perspective Load of patients Loss due to disease
More than 13% of population
Loss due to disease
Life- Considered not significant in comparison to other disease???- It is not true- DATA missing from India
Productive life- Significantly impaired
QOL-significantly impaired- Social disease
Preventable loss by intervention
Primary prevention- currently -education, improving awareness,
Secondary prevention- complication reduction in mortality and morbidity.

9. Specific intervention- economic analysis
From America and Europe
May vary with our population
The major problem in these type of comparison are using harmonization of scale and disease burden
It gives a rough estimate

10. Schopper, D., et al. "Estimating the burden of disease in one Swiss canton: what do disability adjusted life years (DALY) tell us?." International Journal of Epidemiology 29.5 (2000):

11. Rheumatoid arthritis 1%
Calculating impact- logic says RA impact is high. Number says other way. ?
Diabetes 3%
Initial year disability and impairment in QOL is less. It is rather intervention which impairs QOL because of dietary restrictions
The stage of complication is late. Usually after year of disease
Life expectancy is reduced
Rheumatoid arthritis 1%
From the onset of disease QOL drastically drops. Disability is additive
The disability occur very early in the coarse of the disease. The intervention prevents it
Persisting active disease reduced life expectancy

12. It is a tough task- Budget prioritizing-
All are problems and promised to be resolved which one first
How much is the money to be spent and how much is available
A patient suffering from the sickness feels his/her problem is a priority
So also specialist

14. Let us calculate how much expense is incurred per patient -RA
Events
Number per year
Multiplication
Total expenditure in a year
Physician or specialist vist
10-24 *
Investigations including Radiology
4-6
2000
8000
Physiotherapy
2-3
1500
3000
Medication
continues
,000/month
30,000- 9,60,000
Travel to hospital
Depends on distance
,000
Other support required at home like nurse domestic help etc..
Through year if patients fails to do well
,000
,40,000
Indirect loss due to loss of wages and work performance
…./annum

15. Limitation
Calculation of expense is variable- depends on his way of seeking hospital care.
The pattern of compliance
Personal requirement.
Indirect losses depends on the personal worth and capacity.

18. The smile on the face- a few days of life and few more dollars may worth a life time memory
Not included in my analysis.

19. Final thought……..
The economy and financial consideration should not be the restriction while managing or treating a patient. But the ground reality all across the globe is different. This problem is not restricted to countries with limited resources. It is a significant problem in developed countries too. The escalating cost, misjudged and inappropriate restriction and unwanted regulatory costs as well taxation have made some of these treatment non-affordable. When services like health care and disaster management are called industry and the economist and CEO are in charge to administer and to look into profit and loss accounts- the treatment becomes management, suffering patient becomes client; every step taken by hospital and physician is scrutinized in terms of financial return rather than the well being of the patient at the receiving end and physician at the administering end. This need a serious thought from the policy makers………