Rheumatology Advance Access originally published online on August 9, 2005
Rheumatology 2005 44(12):1531-1537; doi:10.1093/rheumatology/kei049
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The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition
1 Department of Health Policy, Management and Evaluation, University of Toronto, 2 Institute for Clinical Evaluative Sciences, 3 Clinical Epidemiology Unit and 4 Division of Rheumatology, Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Correspondence to: P. C. Coyte, Department of Heath Policy, Management and Evaluation, 2nd Floor McMurrich Building, 12 Queen's Park Crescent West, Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada. E-mail: peter.coyte{at}utoronto.ca
Objective. To estimate the direct and indirect arthritis-attributable costs to individuals with disabling hip and/or knee osteoarthritis (OA).
Methods. An established population cohort with disabling hip and/or knee OA from two regions of Ontario, Canada was surveyed to determine participant and caregiver costs related to OA, and the predictors of these costs.
Results. The response rate was 87.2%. Of 1378 respondents, 1258 had OA (mean age 73.1 yr, range 59–100). Sixty per cent (n = 758) reported OA-related costs. Among these individuals, the average annual cost was $12 200 ($CDN in 2002, where $1.00 CDN 
$0.81 US). Time lost from employment and leisure by participants and their unpaid caregivers accounted for 80% of the total. Men were less likely than women to report costs (adjusted odds ratio 0.54, P<0.0001), but when they did their expenditures were significantly higher (P = 0.004). Greater disability was associated with higher costs: compared with individuals with WOMAC total scores <15, those with scores 
55 were 15 times more likely to report costs, and their costs were 3 times greater (both P<0.0001). Both the young (<65 yr) and very old were more likely to incur costs (P<0.0001), and when they did their costs were higher (P<0.001).
Conclusion. Costs incurred were mainly for time lost from employment and leisure, and for unpaid informal caregivers. Failure to value such indirect costs significantly underestimates the true burden of OA. Costs increased with worsening health status and greater OA severity. After adjustment, men were less likely to incur costs, possibly due to greater social resources.
KEY WORDS: Osteoarthritis, Burden of illness, Direct cost, Indirect cost, Survey
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