[Consequences of late access to specialist care-effect on medication costs in rheumatoid arthritis]

Insufficient access to specialist rheumatology services in Germany results in prolonged waiting times and delayed diagnostic confirmation, which impedes timely and effective initiation of therapy.

This study examines the impact of early versus delayed access to specialist care on medication prescribing patterns and associated costs.

A cost analysis was conducted within the Deliver-Care study using health insurance claims data from 2015-2020. Patients with a confirmed rheumatoid arthritis diagnosis (ICD-10 M05/M06) were stratified by the timing of their initial specialist consultation: early access (within the diagnosis quarter, Q1) versus late access (Q2-Q4). Medication costs were compared across these groups.

More than half (57.4%) of M05 patients and about one quarter (24.4%) of M06 patients had no access to a specialist during the first year after the initial suspected diagnosis. Among patients who did have specialist contact (n = 3781), 82.7% obtained early specialist access. Patients with delayed specialist access incurred higher medication costs (€ 4343 in Q4 vs. € 1763 in Q1; p < 0.0001). A sensitivity analysis showed that patients with delayed specialist access were switched to high-cost medications earlier than those with early access.

Early specialist access is associated with reduced biologic prescribing and lower medication costs. These findings highlight that timely diagnosis and treatment not only lessen patient disease burden but also generate substantial cost savings in the management of rheumatoid arthritis.