To propose a new way of looking at value for the (established) rheumatoid arthritis (RA) patients. Through defining health outcomes using patient reported outcomes (PRO’s) and by defining costs of care according to the system of Value based health care (VBHC) for the first time in rheumatoid arthritis a high burden, high cost disease.

Rheumatoid arthritis is an incapacitating  musculoskeletal disease  with high costs both for the patients as for society. In 2011 there were about 110.000 rheumatoid arthritis patients. The projections are that the amount of RA patients will increase with about 25 % from 2011-2013 ( Only about 1/4 of these patient are registered in rheumatology clinics. In the previous decades treatment options for RA patients have greatly improved. In the current era of biologic and very early aggressive treatment, the disease can be slowed down or put to a halt in the majority of cases. Although this comes at a price. In 2011 medication usage for this group of patients was estimated at around half a billion euro’s.  Till present there is no “outcome measurement system” in place  for this group of patients.

In this initiative we defined the care cycle as it is done in real life practice for the established RA patient in order to define the cost. The costs are defined by the method of activity based costing.  This is a first step in defining patient value. Heath outcome however is as of yet not defined for RA patients and must be determined. Next to quality definition on the national stage we initiated a patient oriented initiative to define  health outcome for the RA patients and will collect these outcomes according to the seven tiers as defined by M. Porter. The health outcome will be collected in an automated fashion using a data collection system called gemstracker. In 2016  year we will measure the  “real life” carecycle in order to quantify future improvements of the carecycle.