Table 4.
Economic impacts of delayed diagnosis of axSpA
| Study | Patient population [N] | Definition of delay, years | Economic outcome measures | Patient outcomes |
|---|---|---|---|---|
| Seo MR, et al. 2015 |
SpA [105] |
≤ 8 vs. > 8 | Social disabilitiesa | Higher proportion of patients with delay of > 8 years reported social disabilities compared with those with delay of ≤ 8 years, although the difference did not reach statistical significance (28.3 vs. 12.8%; P = 0.06) |
| Gunasekera W, et al. 2014 |
AS [106] |
Continuous | Work disability |
Patients who were work disabled had a significantly longer delay than those who were not work disabled (mean, 16.6 vs. 7.8 years; P = 0.005) Risk of being work disabled increased by 6.6% per year of delay (OR, 1.07 [CI, 1.0–1.1]; P = 0.0009) |
| Sullivan C, et al. 2014 |
AS [92] |
0–4 vs. 5–9 vs. > 10 vs. unknown | TNFi use | No relationship between diagnostic delay and likelihood of TNFi use |
| Sullivan C, FitzGerald O. 2011 |
AS [59] |
< 4 vs. 5–9 vs. > 10 | Employment | Longer delay was associated with greater likelihood of work disability; unemployment rose from 20 to 29% to 41% among those diagnosed in < 4 years, 5–9 years, and > 10 years, respectively |
| Mennini FS, et al. 2018 |
AxSpA [1084] |
3 years prior to initial SpA diagnosis | Cost (€) of SpA-related specialist visits and treatments | In 3 years prior to SpA diagnosis, patients received an average of 4 specialist services and 4 treatments related to undiagnosed SpA, resulting in an average cost of ≈ €140.90 per patient, corresponding to ≈ €152,767 for study population and ≈ €5,387,972 for Italian population of patients with SpA |
| Abdelrahman FI, Mortada M. 2018 |
AxSpA [126] |
Mean (SD), 11.3 (3.9) vs. 4.6 (2.8) |
Healthcare costs Doctor visits Spinal surgery |
Patients with longer delay had worse economic outcomes than those with shorter delay (all P < 0.001): Cost of delay period, mean (SD): $9879.30 ($3827.20) vs. $2373.90 ($881.80) No. of doctor visits during delay period, mean (SD): 14.3 (6) vs. 5.6 (3.4) Proportion of patients with unnecessary spinal surgery: 65.4 vs. 34.6% |
| Abdul-Sattar A, Abou El Magd S. 2017 |
AS [190] |
Continuous | Work disability |
Patients who were work disabled had significantly longer delay than those who were not work disabled (mean [SD], 8 [2.9] vs. 4 [2.1] years; P < 0.001) Longer delay was associated with greater likelihood of work disability (OR, 2.1 [95% CI, 1.00–3.40]; P = 0.001) |
| Cakar E, et al. 2009 |
AS [121] |
Continuous | Work disability | Patients who were permanently work disabled or changed jobs due to work disability had longer mean (SD) delay (7.8 [6.9] and 7.3 [4.8] years) than those who were not work disabled (3.7 [3.6] years; P = 0.028) |
| Grigg SE, et al. 2011 |
AS [127] |
< 5 vs. 5–10 vs. > 10 |
Treatment costs ($) Employability |
Estimated cost of treatment prior to diagnosis was > $3000 in 25.6% of patients with < 5 years of delay vs. 44.4% with 5–10 years of delay (P = 0.08) and 67.4% with > 10 years of delay (P = 0.002) Employability was affected in 66.7% of patients with < 5 years of delay vs. 75.6% with 5–10 years of delay (P = 0.37) and 90.7% with > 10 years of delay (P = 0.003) |
AS ankylosing spondylitis, axSpA axial spondyloarthritis, OR odds ratio, SpA spondyloarthritis, TNFi tumor necrosis factor inhibitor
aDefined as job changes or the complete discontinuation of work attributable to the disease among workers, discontinued studies among students, and requiring the assistance of another person among homemakers