Cost and Utilization: Trends of Rheumatoid Arthritis Among PBGH Employer Members


In 2017, there were 989 PBGH members from 21 employer-members (0.5%) who had a primary diagnosis of rheumatoid arthritis (RA). The majority of patients were under the age of 65-years-old (82%), and about 68% were female. Globally, RA is prevalent in about 0.3-1% of the population, occurring most often in women during the most productive years of life.

What is Rheumatoid Arthritis?

RA is a progressive condition where symptoms wax and wane. A patient may experience periods of remission altered by flares of debilitating joint pain and swelling that may or may not be predictable. If left untreated, tissue and bone damage often occur and progression of the condition may also affect the heart and lungs. The top three co-morbid conditions in Pennsylvania from Innovu data in 2016 were hypertension (43%), diabetes (15%) and respiratory conditions (15%).


There is no cure for RA. The goal for treatment is a sustained state of clinical remission or low disease activity and consists of medications to treat the symptoms and prevent the disease from progressing, causing irreversible damage to the body. These drugs are referred to as Disease Modifying Antirheumatic Drugs (DMARDS). Approximately 84% of PBGH members with RA are receiving DMARDs. The top two most costly medications for PBGH in 2016-2017 were: Humira = $9,983,282 and Enbrel = $4,903,5274, these agents are indicated for the treatment of RA among other autoimmune conditions. Download the report.

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