Table 1.

Direct and Indirect Costs of Ankylosing Spondylitis by Country

Country (ref)	Year(s)	Total	Direct	Indirect	Comments
U.S. (4)	1994-1999	$6353	27%	33%	High total cost subset-functional disability and pain most important predictors
Belgium (6)	1996-1997	394€	75%	25%	Poor physical function increases patient’s costs and time consumption. Loss of income is associated with lower QoL.
France (6)	1996-1997	252€	44%	56%
Netherlands(7)	2009*	9374€	50%	50%	Productivity costs constitute the largest part of the total cost-of-illness of AS reflecting the high burden of the disease on work participation.
U.K.(8)	2003-2004	1852£	27%	73%	The most severely affected patients incur 50% of the total costs, and physiotherapy accounts for 32% of the total health-care costs in the UK.
Spain (9)	2008*	20328€	23%	77%	Costs increased significantly with worsening disease, in particular diminishing physical function, covering a range between EUR 5000 and EUR 75,000 per patient and year.
Sweden (10)	2005-2007	$12365	47%	53%	The patients with AS treated with biological therapy constituted 80% of the total drug cost, but just 40% of the cost for disability pension.
Mexico (11)	2008*	n.a.	$2289	n.a.	From the patient’s perspective, the cost of AS represents 25% of direct medical costs.
Brazil (12)	2010*	$4597 USD	45%	55%	The average monthly household income for the group was US $520
Tunisia (13)	2006	546€	266€	280€	Most of the factors associated with higher costs were related to greater disease activity.
Hong Kong (14)	2005-2006	$9120 USD	38%	62%	Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs.

^*Year of publication