In a comprehensive analysis of the economic impact of rheumatoid arthritis (RA) in India, researchers from the Karnataka chapter of the Indian Rheumatology Association have documented alarming levels of financial hardship among patients. The multicenter study, published in Health Economics Review, reveals that more than one-quarter of RA patients spend over 20% of their annual family income on treatment, meeting the definition of catastrophic healthcare expenditure (CHE). The cross-sectional investigation, conducted across 17 rheumatology centers throughout Karnataka State between June 2023 and July 2024, enrolled 2,141 patients with confirmed RA. The research team systematically assessed disease-related expenditures including both direct medical and non-medical costs through structured patient interviews and medical record reviews.
The study found that the median annual expenditure for RA treatment was ₹32,200 (approximately $376 USD), with medications accounting for the largest proportion at 41% of total costs. Nearly half of all patients (48.1%) were spending more than 10% of their annual family income on treatment, while 27.1% experienced catastrophic healthcare expenditure defined as exceeding 20% of annual income. The investigators identified several critical factors associated with increased financial burden. Longer delays in referral to rheumatologists (exceeding 12 months), extended disease duration, presence of comorbidities, and higher disability scores were all significantly associated with greater direct medical expenditure. Patients requiring hospitalization faced particularly severe economic consequences, with adjusted odds of CHE nearly nine times higher than those managed on an outpatient basis alone.
Socioeconomic disparities played a prominent role in determining vulnerability to catastrophic costs. Patients from lower socioeconomic strata had 2.66 times higher odds of experiencing CHE, while those with only primary or middle-level education faced 1.57 to 2.01 times increased risk. Rural residents and those seeking care outside metropolitan Bangalore incurred significantly higher expenses, likely reflecting delayed diagnosis and limited access to specialized rheumatology services. The cumulative financial toll proved substantial. Researchers calculated that the median cumulative medical expenditure per patient over the course of their illness was ₹362,800 (approximately $4,241 USD), underscoring the sustained economic burden of this chronic inflammatory condition affecting primarily working-age adults.
Supporting evidence from the National Sample Survey of India, conducted between 2017 and 2018, aligns with these findings by documenting high rates of catastrophic expenditure across various chronic diseases. The Karnataka study extends this knowledge by providing disease-specific insights into RA and identifying modifiable factors that drive excessive costs. The team emphasized that approximately one-third of patients experienced delays exceeding one year before referral to a rheumatologist, contributing to higher subsequent costs and poorer outcomes.
This observation parallels findings from the Netherlands showing that diagnostic delays beyond 12 weeks significantly reduce the likelihood of achieving sustained remission and increase long-term joint damage. The research team noted that despite more than 80% of patients being prescribed conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), medication costs remained the primary financial burden. The study documented that 6% of total expenditure was attributed to managing comorbidities, which were present in 48% of the cohort, with 20% experiencing multiple comorbid conditions.
Based on these findings, the research team calls for urgent policy interventions to reduce the financial toxicity of RA treatment. They emphasize the critical need for early diagnosis, timely specialist referral, and enhanced financial support mechanisms to alleviate the economic strain on patients and their families. The study’s comprehensive assessment across diverse healthcare settings encompassing both academic and non-academic centers, urban and rural populations provide robust evidence to inform healthcare policy and insurance coverage decisions at the state and national levels. This landmark investigation represents the first large-scale pharmacoeconomic analysis of RA conducted in real-world clinical settings across Karnataka, offering crucial data to support evidence-based resource allocation and the development of targeted interventions aimed at reducing catastrophic health expenditure among India’s RA population.
Reference
- Yadav J, Menon GR, John D. Disease-Specific Out-of-Pocket Payments, catastrophic health expenditure and impoverishment effects in india: an analysis of National health survey data. Appl Health Econ Health Policy. 2021;19(5):769–82.
- van der Linden MPM, le Cessie S, Raza K, van der Woude D, Knevel R, Huizinga TWJ, et al. Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum. 2010;62(12):3537–46.
- Shobha V, Singhai S, Haridas V, V. S, R. S, Mamadapur M, et al. The financial repercussions of rheumatoid arthritis and determinants of catastrophic healthcare expenditure: insights from the Karnataka chapter of the Indian rheumatology association. Health Economics Review. 2025 Oct 27;15(1):90.