Costs of Providing Infusion Therapy for Rheumatoid Arthritis in a Hospital-based Infusion Center Setting

Clin Ther. 2017 Aug;39(8):1600-1617. doi: 10.1016/j.clinthera.2017.06.007. Epub 2017 Jul 14.


Purpose: Many hospital-based infusion centers treat patients with rheumatoid arthritis (RA) with intravenous biologic agents, yet may have a limited understanding of the overall costs of infusion in this setting. The purposes of this study were to conduct a microcosting analysis from a hospital perspective and to develop a model using an activity-based costing approach for estimating costs associated with the provision of hospital-based infusion services (preparation, administration, and follow-up) in the United States for maintenance treatment of moderate to severe RA.

Methods: A spreadsheet-based model was developed. Inputs included hourly wages, time spent providing care, supply/overhead costs, laboratory testing, infusion center size, and practice pattern information. Base-case values were derived from data from surveys, published studies, standard cost sources, and expert opinion. Costs are presented in year-2017 US dollars. The base case modeled a hospital infusion center serving patients with RA treated with abatacept, tocilizumab, infliximab, or rituximab.

Findings: Estimated overall costs of infusions per patient per year were $36,663 (rituximab), $36,821 (tocilizumab), $44,973 (infliximab), and $46,532 (abatacept). Of all therapies, the biologic agents represented the greatest share of overall costs, ranging from 87% to $91% of overall costs per year. Excluding infusion drug costs, labor accounted for 53% to 57% of infusion costs.

Implications: Biologic agents represented the highest single cost associated with RA infusion care; however, personnel, supplies, and overhead costs also contributed substantially to overall costs (8%-16%). This model may provide a helpful and adaptable framework for use by hospitals in informing decision making about services offered and their associated financial implications.

Keywords: abatacept; antibodies; arthritis; hospital costs; humanized; infliximab; monoclonal; rheumatoid; rituximab.

MeSH terms

  • Abatacept / administration & dosage
  • Abatacept / economics
  • Abatacept / therapeutic use
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Antibodies, Monoclonal, Humanized / economics
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antirheumatic Agents / administration & dosage
  • Antirheumatic Agents / economics*
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / economics*
  • Home Infusion Therapy / economics*
  • Hospital Costs*
  • Humans
  • Infliximab / administration & dosage
  • Infliximab / economics
  • Infliximab / therapeutic use
  • Infusions, Intravenous / economics
  • Models, Economic
  • Rituximab / administration & dosage
  • Rituximab / economics
  • Rituximab / therapeutic use
  • United States


  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Rituximab
  • Abatacept
  • Infliximab
  • tocilizumab