Ryan Haumschild, PharmD, MS, MBA: When we think about these diseases, we really need to focus on the humanistic burden. Dr Chen, I’d love to get your thoughts as we kick this off. What are some of the humanistic and economic impacts that affect patients with inflammatory diseases? That can range from their quality of life and presenteeism at work to direct medical expenses like ED [emergency department] visits and hospitalizations and even indirect costs such as health care resource utilization. I’d love to hear your perspective on that as a payer.

Kimberly C. Chen, DO, MSHLM: Exactly as you said—patients with rheumatoid disease are impacted significantly in their quality of life because of the pain, the medical treatment, surgeries they go through, and also impaired function. [That] not only [affects] them, but also [affects] their family and their coworkers as well when we talk about direct and indirect economic impacts.

We all know they have such a high health care cost that’s due to…the specialty drugs…as well as surgery and in-patient care. Those are the direct costs…,but some of the indirect costs that you have mentioned [are] a decrease in productivity at work, their coworkers significantly having to help them, as well as earlier disability and disability payment. Also, transportation, medication cost, and the costs for individuals with inflammatory disease can just go on and on, and to your point earlier, the mental health impact is not even being explored.

Ryan Haumschild, PharmD, MS, MBA: Absolutely, I don’t know if any of our colleagues have any more to add. One thing that really stands out to me is as you mentioned, there are other indirect costs in terms of caregiver burden, but also that this disease is something these patients will live with. Our goal is for them to live a highly productive life, but when you have health care resource utilization and have to travel and have transportation vulnerability, [that] can really impact the patient as a whole.

Maia Kayal, MD, MS: I agree, and I think along those lines, exactly as you said Dr Chen. You mentioned disability, and we’re increasingly recognizing that disability is a major comorbidity for these patients, both related to the disease manifestations itself but then also to the stress of the disease and its impact on their day-to-day life.

Something that we’ve been adopting in gastroenterology is actually disability- related quality of life and using that as an outcome for our patients because it’s a big deal for patients to not be able to get through the day, not be able to go to work or manage their personal life. I think we increasingly understand how…immune-mediated inflammatory diseases are impacting disability. We’re recognizing that it’s an outcome that we need to improve upon for their lives.

Jonathan Kay, MD: On a more positive note, in rheumatologic diseases, disability used to be an inevitable consequence of the disease [despite] the treatments that we had, but over the past 25 years with biologics available, disability has been markedly decreased. Patients with rheumatologic diseases can now look forward to normal life and normal function and not necessarily anticipate surgical procedures. It used to be when I started in rheumatology that patients would anticipate having both hips and both knees replaced, surgery on their hands, and nowadays a patient with rheumatoid arthritis treated aggressively can expect to have a normal life managed with once-weekly or biweekly medication.

Maia Kayal, MD, MS: That’s amazing. Just that progress alone is wonderful.

Jonathan Kay, MD: Absolutely.

Kimberly C. Chen, DO, MSHLM: One thing I do think is important to note is the overall cost for these patients. I think a lot of times we focus on the medical expense, but commercial patients tend to be very young because most of our inflammatory [diseases] tend to onset at a younger age. It’s important for us to incorporate those indirect costs like the disability that you guys talk about because many commercial payers are self-funded. And if we just look at it as we compare it with Medicaid or Medicare, I think we’re not…looking at what the commercial payers are paying for that.

Transcript edited for clarity.

This activity is supported by an educational grant from Boehringer Ingelheim.