Investigating associations between access to rheumatology care, treatment, continuous care and healthcare utilization and costs among older individuals with RA

Objective — To examine the association between rheumatologist access, early treatment and ongoing care of older onset rheumatoid arthritis (RA) and healthcare utilization and costs following diagnosis.

Methods — We analyzed data from a population-based inception cohort of individuals age >65 years with RA in Ontario, Canada diagnosed between 2002-2014 with follow-up to 2019. We assessed four performance measures in the first four years following diagnosis, including access to rheumatology care, yearly follow-up, timely treatment, and ongoing treatment with a disease modifying anti-rheumatic drug. We examined annual healthcare utilization, mean direct healthcare costs, and whether the performance measures were associated with costs in year five.

Results — 13,293 individuals met inclusion criteria: mean age (standard deviation) was 73.7 (5.7) years and 68% were female. Total mean direct healthcare cost per individual increased annually and was $13,929 CAD in year five. All four performance measures were met for 35% of individuals. In multivariable analyses, costs (95% confidence interval) for not meeting access to rheumatology care and timely treatment performance measures were 20% (8-32%) and 6% (112%) respectively higher than where those measures were met. The main driver of cost savings among individuals meeting all four performance measures were from lower complex continuing care, home care and long-term care costs, as well as fewer hospitalizations and emergency visits.

Conclusion — Access to rheumatologists for RA diagnosis, timely treatment and ongoing care are associated with lower total healthcare costs at five years. Investments in improving access to care may be associated with long-term health system savings.