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Rheumatology Advance Access originally published online on March 3, 2007
Rheumatology 2007 46(6):968-974; doi:10.1093/rheumatology/kem018
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Trends in economic consequences of rheumatoid arthritis over two subsequent years

S. M. M. Verstappen, J. W. G. Jacobs, A. A. Kruize, J. C. Ehrlich1, G. A. van Albada-Kuipers2, H. Verkleij3, E. Buskens4 and J. W. J. Bijlsma

University Medical Center Utrecht, Utrecht, 1Hilversum Hospital, Hilversum, 2Meander Medical Center, Amersfoort, 3National Institute of Public Health and the Environment, Bilthoven and 4Julius Centre for Health Sciences and Primary Care, UMC Utrecht, The Netherlands

Correspondence to: J.W.G. Jacobs, University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology, F02.127 PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail: j.w.g.jacobs{at}umcutrecht.nl


  Abstract

Objective. To examine changes in direct costs and in working status over 2 yrs in patients with rheumatoid arthritis (RA).

Patients and methods. In both 1999 and 2000, RA patients (n = 461) filled out a questionnaire retrospectively regarding utilization of health care, other RA-related direct costs and working status. Patients were categorized into four disease duration groups: 0–2 yrs, 2–6 yrs, 6–10 yrs and >10 yrs. At the same time points, disease activity was assessed. Logistic regression analyses were performed to identify a possible association between disease activity (high >66th percentile) measured at start of the second year and high direct costs (high >66th percentile) in the second year.

Results. Compared with the first year, a significant decrease in the costs for contacts with health care workers and for costs for laboratory tests was observed in the second year for the <2 yrs group. In the 2–6 yrs group and the >10 yrs group, we found a significant decrease in costs for devices and adaptations, but medication costs increased in the <2 yrs and the >10 yrs group in the second year. In the >10 yrs group, this was mainly due to an increasing number of patients who started to use biological agents during the second year. In all four disease duration groups, worse Visual Analogue Scale (VAS) disease activity and VAS general well-being were significantly associated with high direct costs. Of 97 patients working without disability at time of the first assessment, 12 (12%) patients became (partial) work disabled during follow-up.

Conclusion. In particular, costs for devices/adaptations and for medication changed during follow-up. The latter was probably due to an increase in the use of biological agents. Hopefully a decrease in direct costs and a reduced percentage of patients getting work disabled by better disease control will outweigh the high costs of biological drugs in the future.

KEY WORDS: Rheumatoid arthritis, Direct costs, Working status, 2 yr follow-up

Submitted 16 October 2006; revised version accepted 9 January 2007.
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