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. 2003 Aug;62(8):732–740. doi: 10.1136/ard.62.8.732

Direct costs of ankylosing spondylitis and its determinants: an analysis among three European countries

A Boonen 1, D van der Heijde 1, R Landewe 1, F Guillemin 1, M Rutten-van 1, M Dougados 1, H Mielants 1, K de Vlam 1, H van der Tempel 1, S Boesen 1, A Spoorenberg 1, H Schouten 1, S van der Linden 1
PMCID: PMC1754632  PMID: 12860728

Abstract

Objective: To assess direct costs associated with ankylosing spondylitis (AS). To determine which variables, including country, predict costs.

Methods: 216 patients with AS from the Netherlands, France, and Belgium participated in a two year observational study and filled in bimonthly economic questionnaires. Disease related healthcare resource use was measured and direct costs were calculated from a societal perspective (true cost estimates) and from a financial perspective (country-specific tariffs). Predictors of costs were assessed using Cox's regression analysis.

Results: 209 patients provided sufficient data for cost analysis. Mean annual societal direct costs for each patient were €2640, of which 82% were direct healthcare costs. In univariate analysis costs were higher in the Netherlands than in Belgium, but this difference disappeared after adjusting for baseline differences in patients' characteristics among countries. Longer disease duration, lower education, worse physical function, and higher disease activity were predictors of costs. Mean annual direct costs from a financial perspective were €2122, €1402, and €941 per patient in the Netherlands, France, and Belgium, respectively. For each country, costs from a financial perspective were significantly lower than costs from a societal perspective.

Conclusion: Direct costs for AS are substantial in three European countries but not significantly different after adjusting for baseline characteristics among countries. Worse physical function and higher disease activity are important determinants of costs, suggesting better disease control might reduce the costs of AS. The difference in costs from a societal and financial perspective emphasises the importance of an economic analysis.

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Selected References

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  1. Bloom B. S., Bruno D. J., Maman D. Y., Jayadevappa R. Usefulness of US cost-of-illness studies in healthcare decision making. Pharmacoeconomics. 2001;19(2):207–213. doi: 10.2165/00019053-200119020-00007. [DOI] [PubMed] [Google Scholar]
  2. Boonen A., Chorus A., Miedema H., van der Heijde D., van der Tempel H., van der Linden S. Employment, work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis. 2001 Apr;60(4):353–358. doi: 10.1136/ard.60.4.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Boonen A., van der Heijde D., Landewé R., Spoorenberg A., Schouten H., Rutten-van Mölken M., Guillemin F., Dougados M., Mielants H., de Vlam K. Work status and productivity costs due to ankylosing spondylitis: comparison of three European countries. Ann Rheum Dis. 2002 May;61(5):429–437. doi: 10.1136/ard.61.5.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boonen A., van der Heijde D., Landewé R., Spoorenberg A., Schouten H., Rutten-van Mölken M., Guillemin F., Dougados M., Mielants H., de Vlam K. Work status and productivity costs due to ankylosing spondylitis: comparison of three European countries. Ann Rheum Dis. 2002 May;61(5):429–437. doi: 10.1136/ard.61.5.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Braun J., Bollow M., Remlinger G., Eggens U., Rudwaleit M., Distler A., Sieper J. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 1998 Jan;41(1):58–67. doi: 10.1002/1529-0131(199801)41:1<58::AID-ART8>3.0.CO;2-G. [DOI] [PubMed] [Google Scholar]
  6. Byford S., Torgerson D. J., Raftery J. Economic note: cost of illness studies. BMJ. 2000 May 13;320(7245):1335–1335. doi: 10.1136/bmj.320.7245.1335. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Calin A., Garrett S., Whitelock H., Kennedy L. G., O'Hea J., Mallorie P., Jenkinson T. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994 Dec;21(12):2281–2285. [PubMed] [Google Scholar]
  8. Clarke A. E., Petri M. A., Manzi S., Isenberg D. A., Gordon C., Senecal J. L., St Pierre Y., Joseph L., Penrod J., Fortin P. R. An international perspective on the well being and health care costs for patients with systemic lupus erythematosus. Tri-Nation Study Group. J Rheumatol. 1999 Jul;26(7):1500–1511. [PubMed] [Google Scholar]
  9. Cooper N. J. Economic burden of rheumatoid arthritis: a systematic review. Rheumatology (Oxford) 2000 Jan;39(1):28–33. doi: 10.1093/rheumatology/39.1.28. [DOI] [PubMed] [Google Scholar]
  10. Dalyan M., Güner A., Tuncer S., Bilgiç A., Arasil T. Disability in ankylosing spondylitis. Disabil Rehabil. 1999 Feb;21(2):74–79. doi: 10.1080/096382899298007. [DOI] [PubMed] [Google Scholar]
  11. Esdaile J. M., Sampalis J. S., Lacaille D., Danoff D. The relationship of socioeconomic status to subsequent health status in systemic lupus erythematosus. Arthritis Rheum. 1988 Mar;31(3):423–427. doi: 10.1002/art.1780310315. [DOI] [PubMed] [Google Scholar]
  12. Garrett S., Jenkinson T., Kennedy L. G., Whitelock H., Gaisford P., Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994 Dec;21(12):2286–2291. [PubMed] [Google Scholar]
  13. Goossens M. E., Rutten-van Mölken M. P., Vlaeyen J. W., van der Linden S. M. The cost diary: a method to measure direct and indirect costs in cost-effectiveness research. J Clin Epidemiol. 2000 Jul;53(7):688–695. doi: 10.1016/s0895-4356(99)00177-8. [DOI] [PubMed] [Google Scholar]
  14. Gran J. T., Skomsvoll J. F. The outcome of ankylosing spondylitis: a study of 100 patients. Br J Rheumatol. 1997 Jul;36(7):766–771. doi: 10.1093/rheumatology/36.7.766. [DOI] [PubMed] [Google Scholar]
  15. Hodgson T. A. Costs of illness in cost-effectiveness analysis. A review of the methodology. Pharmacoeconomics. 1994 Dec;6(6):536–552. doi: 10.2165/00019053-199406060-00007. [DOI] [PubMed] [Google Scholar]
  16. Karlson E. W., Daltroy L. H., Lew R. A., Wright E. A., Partridge A. J., Fossel A. H., Roberts W. N., Stern S. H., Straaton K. V., Wacholtz M. C. The relationship of socioeconomic status, race, and modifiable risk factors to outcomes in patients with systemic lupus erythematosus. Arthritis Rheum. 1997 Jan;40(1):47–56. doi: 10.1002/art.1780400108. [DOI] [PubMed] [Google Scholar]
  17. Koopmanschap M. A. Cost-of-illness studies. Useful for health policy? Pharmacoeconomics. 1998 Aug;14(2):143–148. doi: 10.2165/00019053-199814020-00001. [DOI] [PubMed] [Google Scholar]
  18. Koopmanschap M. A., Rutten F. F. A practical guide for calculating indirect costs of disease. Pharmacoeconomics. 1996 Nov;10(5):460–466. doi: 10.2165/00019053-199610050-00003. [DOI] [PubMed] [Google Scholar]
  19. Lubeck D. P., Spitz P. W., Fries J. F., Wolfe F., Mitchell D. M., Roth S. H. A multicenter study of annual health service utilization and costs in rheumatoid arthritis. Arthritis Rheum. 1986 Apr;29(4):488–493. doi: 10.1002/art.1780290405. [DOI] [PubMed] [Google Scholar]
  20. Miedema H. S., van der Linden S. M., Rasker J. J., Valkenburg H. A. National database of patients visiting rheumatologists in The Netherlands: the standard diagnosis register of rheumatic diseases. A report and preliminary analysis. Br J Rheumatol. 1998 May;37(5):555–561. doi: 10.1093/rheumatology/37.5.555. [DOI] [PubMed] [Google Scholar]
  21. Mäkisara G. L., Mäkisara P. Prognosis of functional capacity and work capacity in rheumatoid arthritis. Clin Rheumatol. 1982 Jun;1(2):117–125. doi: 10.1007/BF02275601. [DOI] [PubMed] [Google Scholar]
  22. Newhall-Perry K., Law N. J., Ramos B., Sterz M., Wong W. K., Bulpitt K. J., Park G., Lee M., Clements P., Paulus H. E. Direct and indirect costs associated with the onset of seropositive rheumatoid arthritis. Western Consortium of Practicing Rheumatologists. J Rheumatol. 2000 May;27(5):1156–1163. [PubMed] [Google Scholar]
  23. Oostenbrink J. B., Rutten-van Mölken M. P., Sluyter-Opdenoordt T. S. Resource use and costs of patients with glaucoma or ocular hypertension: a one-year study based on retrospective chart review in the Netherlands. J Glaucoma. 2001 Jun;10(3):184–191. doi: 10.1097/00061198-200106000-00007. [DOI] [PubMed] [Google Scholar]
  24. Rice D. P. Cost of illness studies: what is good about them? Inj Prev. 2000 Sep;6(3):177–179. doi: 10.1136/ip.6.3.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Rivest C., Lew R. A., Welsing P. M., Sangha O., Wright E. A., Roberts W. N., Liang M. H., Karlson E. W. Association between clinical factors, socioeconomic status, and organ damage in recent onset systemic lupus erythematosus. J Rheumatol. 2000 Mar;27(3):680–684. [PubMed] [Google Scholar]
  26. Ruof J., Merkesdal S., Huelsemann J. L., Schoeffski O., Maetzel A., Mau W., Zeidler H. Cost assessment instrument in rheumatology: evaluation of applied instrument characteristics. J Rheumatol. 2001 Mar;28(3):662–665. [PubMed] [Google Scholar]
  27. Sailly J. C., Lebrun T. Les conséquences économiques et sociales de la pelvispondylite rhumatismale. Rev Epidemiol Sante Publique. 1982;30(3):305–324. [PubMed] [Google Scholar]
  28. Sutcliffe N., Clarke A. E., Gordon C., Farewell V., Isenberg D. A. The association of socio-economic status, race, psychosocial factors and outcome in patients with systemic lupus erythematosus. Rheumatology (Oxford) 1999 Nov;38(11):1130–1137. doi: 10.1093/rheumatology/38.11.1130. [DOI] [PubMed] [Google Scholar]
  29. Sutcliffe N., Clarke A. E., Levinton C., Frost C., Gordon C., Isenberg D. A. Associates of health status in patients with systemic lupus erythematosus. J Rheumatol. 1999 Nov;26(11):2352–2356. [PubMed] [Google Scholar]
  30. Verhoeven A. C., Bibo J. C., Boers M., Engel G. L., van der Linden S. Cost-effectiveness and cost-utility of combination therapy in early rheumatoid arthritis: randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone. COBRA Trial Group. Combinatietherapie Bij Reumatoïde Artritis. Br J Rheumatol. 1998 Oct;37(10):1102–1109. doi: 10.1093/rheumatology/37.10.1102. [DOI] [PubMed] [Google Scholar]
  31. Ward Michael M. Functional disability predicts total costs in patients with ankylosing spondylitis. Arthritis Rheum. 2002 Jan;46(1):223–231. doi: 10.1002/1529-0131(200201)46:1<223::AID-ART498>3.0.CO;2-#. [DOI] [PubMed] [Google Scholar]
  32. Yelin E. H., Henke C. J., Kramer J. S., Nevitt M. C., Shearn M., Epstein W. V. A comparison of the treatment of rheumatoid arthritis in health maintenance organizations and fee-for-service practices. N Engl J Med. 1985 Apr 11;312(15):962–967. doi: 10.1056/NEJM198504113121506. [DOI] [PubMed] [Google Scholar]
  33. Yelin E., Herrndorf A., Trupin L., Sonneborn D. A national study of medical care expenditures for musculoskeletal conditions: the impact of health insurance and managed care. Arthritis Rheum. 2001 May;44(5):1160–1169. doi: 10.1002/1529-0131(200105)44:5<1160::AID-ANR199>3.0.CO;2-Y. [DOI] [PubMed] [Google Scholar]
  34. Yelin E., Meenan R., Nevitt M., Epstein W. Work disability in rheumatoid arthritis: effects of disease, social, and work factors. Ann Intern Med. 1980 Oct;93(4):551–556. doi: 10.7326/0003-4819-93-4-551. [DOI] [PubMed] [Google Scholar]
  35. van der Linden S. M., Valkenburg H. A., de Jongh B. M., Cats A. The risk of developing ankylosing spondylitis in HLA-B27 positive individuals. A comparison of relatives of spondylitis patients with the general population. Arthritis Rheum. 1984 Mar;27(3):241–249. doi: 10.1002/art.1780270301. [DOI] [PubMed] [Google Scholar]

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