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Feng J, Zhang K, Dou L, Shi Z, Chen G, Li S. Health state utility values in patients with Ankylosing Spondylitis: a systematic review and meta-analysis. Qual Life Res 2024:10.1007/s11136-024-03670-8. [PMID: 38824212 DOI: 10.1007/s11136-024-03670-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is a chronic condition that requires lifelong treatment and results in a serious disease burden. Health state utility values (HSUVs) are a valuable tool for quantifying this burden and conducting cost-utility analysis. OBJECTIVE We conducted a systematic review and meta-analysis to obtain estimates of HSUVs in patients with AS, explored potential sources of heterogeneity, and compared pooled patient HSUVs with population norms. METHOD We searched PubMed, Embase, Web of science, Cochrane database and Scopus until July, 2023 to obtain eligible studies. The methodological quality of the included studies was assessed using the ROBINS-I checklist. RESULTS Forty-two publications involving 11,354 participants were included in this systematic review. The most commonly used instrument is the EQ-5D (38 studies). The estimated HSUVs for patients with AS from all available studies was pooled as 0.62 (95% CI 0.59 to 0.65). The pooled mean utility estimates from the random effects meta-analysis for SF-6D, EQ-5D-3L, EQ-5D-5L, and HUI3 were 0.65 (95% CI 0.62,0.68), 0.63 (95% CI 0.59,0.66), 0.60 (95% CI 0.42,0.79), and 0.48 (95% CI 0.43,0.53), respectively. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression based on key subgroups. The pooled estimates of EQ-5D-3L were lower for patients published before 2010, with high disease activity, long duration of disease, and in developed countries. CONCLUSION Pooled estimates of HSUVs for people with AS were substantially lower than population norms. These estimates provide robust evidence that can inform the economic evaluation of new therapies for individuals with AS.
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Affiliation(s)
- JunChao Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | | | - Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, 3145, Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Jinan, 250012, China.
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Cortes-Rodríguez A, Alves-Gomes L, Losa-Iglesias ME, Gómez-Salgado J, Becerro-de-Bengoa-Vallejo R, Saavedra-García MÁ, Montiel-Luque A, López-López D, Jiménez-Cebrián AM. Impact of ankylosing spondylitis on foot health and quality of life: an observational case-control study. Front Med (Lausanne) 2024; 11:1355803. [PMID: 38737760 PMCID: PMC11082285 DOI: 10.3389/fmed.2024.1355803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/02/2024] [Indexed: 05/14/2024] Open
Abstract
Background Ankylosing spondylitis (AS) is a chronic, inflammatory, and autoimmune disease. This condition primarily affects the axial skeleton and presents direct foot involvement, such as Achilles enthesitis or plantar fascia involvement. Objective This study aimed to investigate the impact of foot health on the quality of life of individuals with AS compared to a control group without AS. Materials and methods A sample of 112 subjects was recruited, with a mean age of 46.80 ± 10.49 years, divided into two groups: 56 individuals with AS (cases) and 56 individuals without AS (controls). Demographic data were collected, and the scores obtained in the Foot Health Status Questionnaire domains were recorded. Results Of the participants, 27.79% (N = 30) were men and 73.21% (N = 82) were women. The mean age in the group was 46.80 ± 10.49. Significant differences (p < 0.05) were found in the domains of foot function, foot pain, footwear, overall foot health, general health-related physical activity, and social capacity between the AS group and the control group. Conclusion Individuals with AS exhibited a decreased quality of life, as indicated by their Foot Health Status Questionnaire scores.
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Affiliation(s)
- Antonio Cortes-Rodríguez
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Industrial Campus of Ferrol, Ferrol, Spain
| | - Lisa Alves-Gomes
- Nursing School, Nursing Research Centre (CIEnf) of the University of Minho, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, Braga, Portugal
| | | | - Juan Gómez-Salgado
- Departamento de Sociología, Trabajo Social y Salud Pública, Universidad de Huelva, Huelva, Spain
- Programa de Posgrado de Seguridad y Salud, Universidad Espíritu Santo, Guayaquil, Ecuador
| | | | | | - Alonso Montiel-Luque
- Health District Costa del Sol, Department of Nursing and Podiatry, Faculty of Health Sciences, Primary Health Care Centre San Miguel (Torremolinos), Málaga, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Industrial Campus of Ferrol, Ferrol, Spain
| | - Ana María Jiménez-Cebrián
- Department Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
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Grewal G, Polisetty T, Cannon D, Ardeljan A, Vakharia RM, Rodriguez HC, Levy JC. Alcohol Abuse, Morbid Obesity, Depression, Congestive Heart Failure, and Chronic Pulmonary Disease are Risk Factors for 90-Day Readmission After Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2022; 4:e1683-e1691. [PMID: 36312727 PMCID: PMC9596891 DOI: 10.1016/j.asmr.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to report the rate and causes of 90-day readmissions after arthroscopic rotator cuff repair. Methods A retrospective query from January 2005 to March 2014 was performed using a nationwide administrative claims registry. Patients and complications were identified using International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Patients who underwent arthroscopic rotator cuff repair (RCR) and were readmitted within 90 days after their index procedure were identified. Patients not readmitted represented controls. Patients readmitted were stratified into separate cohorts depending on the primary cause of readmission, which included cardiac, endocrine, hematological, infectious, gastrointestinal, musculoskeletal (MSK), neoplastic, neurological or psychiatric, pulmonary, and renal. Risk factors assessed were comorbidities comprising the Elixhauser-Comorbidity Index (ECI). Primary outcomes analyzed and compared included cause for readmission, patient demographics, risk factors, in-hospital length of stay (LOS), and costs. Pearson’s chi-square was used to compare patient demographics, and multivariate binomial logistic regression was used to calculate odds ratios (OR) on patient-related risk factors for 90-day readmissions. Results 10,425 readmitted patients and 301,625 control patients were identified, representing a 90-day readmission rate of 3.5%. The causes of readmissions were primarily related to infectious diseases (15%), MSK (15%), and cardiac (14%) complications. The most common MSK readmissions were osteoarthrosis of the leg or shoulder (24.8%) and spinal spondylosis (8.4%). Multivariate binomial logistic regression analyses demonstrated patients with alcohol abuse (OR, 1.42; P < .0001), morbid obesity (OR, 1.38; P < .0001), depression (OR, 1.35; P < .0001), congestive heart failure (OR, 1.34; P < 0.0001), and chronic pulmonary disease (OR, 1.28; P < .0001) were at the greatest risk of readmissions after RCR. Conclusions Significant differences exist among patients readmitted, and those patients who do not require hospital readmission within 90 days following arthroscopic rotator cuff repairs. Readmissions are associated with significant patient comorbidities and were primarily related to medically based complications. Level of Evidence Level III, prognostic, retrospective cohort study.
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Mars NJ, Kerola AM, Kauppi MJ, Pirinen M, Elonheimo O, Sokka-Isler T. Patients with rheumatic diseases share similar patterns of healthcare resource utilization. Scand J Rheumatol 2019; 48:300-307. [PMID: 30836033 DOI: 10.1080/03009742.2018.1559878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.
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Affiliation(s)
- N J Mars
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland
| | - A M Kerola
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - M J Kauppi
- c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland.,d School of Medicine , University of Tampere , Tampere , Finland
| | - M Pirinen
- b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland.,e Helsinki Institute for Information Technology HIIT and Department of Mathematics and Statistics , University of Helsinki , Helsinki , Finland.,f Department of Public Health , University of Helsinki , Helsinki , Finland
| | - O Elonheimo
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - T Sokka-Isler
- g Department of Medicine , Jyväskylä Central Hospital , Jyväskylä , Finland
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Sindlinger K, Meng K, Dorn M, Faller H, Schuler M. Illness representations, pain and physical function in patients with rheumatic disorders: between- and within-person associations. Psychol Health 2018; 34:200-215. [PMID: 30358411 DOI: 10.1080/08870446.2018.1523406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined. DESIGN AND MAIN OUTCOME MEASURES This secondary analysis is based on data from N = 186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation. METHODS To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models. RESULTS On both the between-person level (r = |0.21| - |0.44|) and the within-person level (r = |0.15| - |0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF. CONCLUSION IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.
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Affiliation(s)
- K Sindlinger
- a Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences , University of Würzburg , Würzburg , Germany
| | - K Meng
- a Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences , University of Würzburg , Würzburg , Germany
| | - M Dorn
- b Rehabilitation Center Bad Eilsen , Bad Eilsen , Germany
| | - H Faller
- a Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences , University of Würzburg , Würzburg , Germany
| | - M Schuler
- a Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences , University of Würzburg , Würzburg , Germany
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Wallman JK, Eriksson JK, Nilsson JÅ, Olofsson T, Kristensen LE, Neovius M, Geborek P. Costs in Relation to Disability, Disease Activity, and Health-related Quality of Life in Rheumatoid Arthritis: Observational Data from Southern Sweden. J Rheumatol 2016; 43:1292-9. [DOI: 10.3899/jrheum.150617] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/22/2022]
Abstract
Objective.To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA).Methods.Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005–2010. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare (patient care and drugs) and work loss costs (patients < 65 yrs) were studied in separate regression models, comparing standardized β coefficients by nonparametric bootstrapping to assess which measure best reflects costs. Analyses were conducted based on both individual means (linear regression, comparing between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs.Results.Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work loss costs were also more closely associated with EQ-5D than DAS28. The results of the linear models for healthcare costs were standardized β = 0.21 (95% CI 0.15–0.27), 0.16 (0.11–0.21), and –0.15 (−0.21 to −0.10) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D). For work loss costs, the results were standardized β = 0.43 (95% CI 0.39–0.48), 0.27 (0.23–0.32), and −0.34 (−0.38 to −0.29) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D and for EQ-5D vs DAS28).Conclusion.Overall, HAQ disability is a better marker of RA costs than DAS28 or EQ-5D HRQOL.
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Cooksey R, Husain MJ, Brophy S, Davies H, Rahman MA, Atkinson MD, Phillips CJ, Siebert S. The Cost of Ankylosing Spondylitis in the UK Using Linked Routine and Patient-Reported Survey Data. PLoS One 2015; 10:e0126105. [PMID: 26185984 PMCID: PMC4506082 DOI: 10.1371/journal.pone.0126105] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/31/2015] [Indexed: 11/19/2022] Open
Abstract
Background Ankylosing spondylitis (AS) is a chronic inflammatory arthritis which typically begins in early adulthood and impacts on healthcare resource utilisation and the ability to work. Previous studies examining the cost of AS have relied on patient-reported questionnaires based on recall. This study uses a combination of patient-reported and linked-routine data to examine the cost of AS in Wales, UK. Methods Participants in an existing AS cohort study (n = 570) completed questionnaires regarding work status, out-of-pocket expenses, visits to health professionals and disease severity. Participants gave consent for their data to be linked to routine primary and secondary care clinical datasets. Health resource costs were calculated using a bottom-up micro-costing approach. Human capital costs methods were used to estimate work productivity loss costs, particularly relating to work and early retirement. Regression analyses were used to account for age, gender, disease activity. Results The total cost of AS in the UK is estimated at £19016 per patient per year, calculated to include GP attendance, administration costs and hospital costs derived from routine data records, plus patient-reported non-NHS costs, out-of-pocket AS-related expenses, early retirement, absenteeism, presenteeism and unpaid assistance costs. The majority of the cost (>80%) was as a result of work-related costs. Conclusion The major cost of AS is as a result of loss of working hours, early retirement and unpaid carer’s time. Therefore, much of AS costs are hidden and not easy to quantify. Functional impairment is the main factor associated with increased cost of AS. Interventions which keep people in work to retirement age and reduce functional impairment would have the greatest impact on reducing costs of AS. The combination of patient-reported and linked routine data significantly enhanced the health economic analysis and this methodology that can be applied to other chronic conditions.
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Affiliation(s)
- Roxanne Cooksey
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
| | - Muhammad J. Husain
- Keele Management School, Keele University, Keele, Newcastle, England, United Kingdom
| | - Sinead Brophy
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Helen Davies
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | | | - Mark D. Atkinson
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Ceri J. Phillips
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland, United Kingdom
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De Cock D, Van der Elst K, Meyfroidt S, Verschueren P, Westhovens R. The optimal combination therapy for the treatment of early rheumatoid arthritis. Expert Opin Pharmacother 2015; 16:1615-25. [PMID: 26058860 DOI: 10.1517/14656566.2015.1056735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune condition traditionally viewed as a severe destructive disease affecting physical health and global wellbeing. The treatment strategies for RA have changed in the last decades from mainly symptomatic towards a more vigorous and targeted approach. AREA COVERED Reviewing recent literature enhanced by own expertise and research, a case is made for starting early with an intensive combination treatment with glucocorticoids, followed by a treat to target approach in a tight control setting. Implementation issues that need to be addressed to make optimal use of the 'window of opportunity' are highlighted. EXPERT OPINION There is strong evidence in favor of traditional synthetic disease-modifying anti-rheumatic drugs (DMARDs) combined with a remission induction scheme of glucocorticoids to achieve adequate efficacy in controlling early rheumatoid arthritis with good safety and feasibility in daily clinical practice. Furthermore, the most optimal RA treatment should address not only the physician-oriented clinical disease outcomes but also the patient perspective. There is still a need for working on improving implementation of this approach in daily practice in order to provide optimal treatment benefit to more patients.
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Affiliation(s)
- Diederik De Cock
- Skeletal Biology and Engineering Research Center, KU Leuven Department of Development and Regeneration , Leuven , Belgium +016 346 350 ; +016 342 543 ;
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Vilsteren MV, Boot CRL, Steenbeek R, Schaardenburg DV, Voskuyl AE, Anema JR. An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study. BMC Public Health 2012; 12:496. [PMID: 22747949 PMCID: PMC3528624 DOI: 10.1186/1471-2458-12-496] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 06/26/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Workers with rheumatoid arthritis (RA) often experience restrictions in functioning at work and participation in employment. Strategies to maintain work productivity exist, but these interventions do not involve the actual workplace. Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA. METHODS/DESIGN This study is a randomized controlled trial (RCT) in specialized rheumatology treatment centers in or near Amsterdam, the Netherlands. Randomisation to either the control or the intervention group is performed at patient level. Both groups will receive care as usual by the rheumatologist, and patients in the intervention group will also take part in the intervention program. The intervention program consists of two components; integrated care, including a participatory workplace intervention. Integrated care involves a clinical occupational physician, who will act as care manager, to coordinate the care. The care manager has an intermediate role between clinical and occupational care. The participatory workplace intervention will be guided by an occupational therapist, and involves problem solving by the patient and the patients' supervisor. The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work. Data collection will take place at baseline and after 6 and 12 months by means of a questionnaire. The primary outcome measure is work productivity, measured by hours lost from work due to presenteeism. Secondary outcome measures include sick leave, quality of life, pain and fatigue. Cost-effectiveness of the intervention program will be evaluated from the societal perspective. DISCUSSION Usual care of primary and outpatient health services is not aimed at improving work productivity. Therefore it is desirable to develop interventions aimed at improving functioning at work. If the intervention program will be (cost)effective, substantial improvements in work productivity might be obtained among workers with RA at lower costs. Results are expected in 2015. TRIAL REGISTRATION NUMBER NTR2886.
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Affiliation(s)
- Myrthe van Vilsteren
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Body@Work, Research Center Physical Activity, TNO-VU University Medical Center, Hoofddorp, the Netherlands
- Jan van Breemen Research Institute | Reade, Amsterdam, the Netherlands
| | - Cécile RL Boot
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Body@Work, Research Center Physical Activity, TNO-VU University Medical Center, Hoofddorp, the Netherlands
| | - Romy Steenbeek
- Body@Work, Research Center Physical Activity, TNO-VU University Medical Center, Hoofddorp, the Netherlands
- TNO Work and Health, Amsterdam, the Netherlands
| | | | - Alexandre E Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Body@Work, Research Center Physical Activity, TNO-VU University Medical Center, Hoofddorp, the Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VU University Medical Center, Amsterdam, the Netherlands
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Abstract
Ankylosing spondylitis (AS) is associated with both significant direct and indirect costs, which vary by country, and have generally increased dramatically since the introduction of anti-tumor necrosis factor therapy. The cost-effectiveness of biologic agents is controversial, although cost-effectiveness studies need to consider the potential impact of anti-tumor necrosis factor treatments on work ability. Alternatives to reduce costs associated with biologics have been examined, including on-demand dosing and lower dose alternatives. Other treatment measures, such as total hip arthroplasty and physical therapy, are also effective in reducing pain and improving function in patients with AS, although the optimal type or combination of physical therapy treatment modalities, the optimal frequency and duration of treatment and whether therapy is equally effective in stable disease and uncontrolled AS need to be determined. No studies have examined differences in patient outcomes based on subspecialty care. Establishing an evidence base for these questions would help inform policy decisions to design the most cost-effective measures to treat AS.
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Affiliation(s)
- John D Reveille
- Division of Rheumatology, University of Texas-Houston Health Science Center, 77030, USA.
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Metsios GS, Stavropoulos-Kalinoglou A, Treharne GJ, Nevill AM, Sandoo A, Panoulas VF, Toms TE, Koutedakis Y, Kitas GD. Disease activity and low physical activity associate with number of hospital admissions and length of hospitalisation in patients with rheumatoid arthritis. Arthritis Res Ther 2011; 13:R108. [PMID: 21714856 PMCID: PMC3218923 DOI: 10.1186/ar3390] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/27/2011] [Accepted: 06/29/2011] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Substantial effort has been devoted for devising effective and safe interventions to reduce preventable hospital admissions in chronic disease patients. In rheumatoid arthritis (RA), identifying risk factors for admission has important health policy implications, but knowledge of which factors cause or prevent hospital admissions is currently lacking. We hypothesised that disease activity/severity and physical activity are major predictors for the need of hospitalisation in patients with RA. METHODS A total of 244 RA patients were assessed for: physical activity (International Physical Activity Questionnaire), RA activity (C-reactive protein: CRP; disease activity score: DAS28) and disability (Health Assessment Questionnaire: HAQ). The number of hospital admissions and length of hospitalisation within a year from baseline assessment were collected prospectively. RESULTS Disease activity and disability as well as levels of overall and vigorous physical activity levels correlated significantly with both the number of admissions and length of hospitalisation (P < 0.05); regression analyses revealed that only disease activity (DAS28) and physical activity were significant independent predictors of numbers of hospital admissions (DAS28: (exp(B) = 1.795, P = 0.002 and physical activity: (exp(B) = 0.999, P = 0.046)) and length of hospitalisation (DAS28: (exp(B) = 1.795, P = 0.002 and physical activity: (exp(B) = 0.999, P = 0.046). Sub-analysis of the data demonstrated that only 19% (n = 49) of patients engaged in recommended levels of physical activity. CONCLUSIONS This study provides evidence that physical activity along with disease activity are important predictors of the number of hospital admissions and length of hospitalisation in RA. The combination of lifestyle changes, particularly increased physical activity along with effective pharmacological therapy may improve multiple health outcomes as well as cost of care for RA patients.
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Affiliation(s)
- George S Metsios
- Department of Physical Activity, Exercise and Health, University of Wolverhampton, Gorway Road, Walsall, WS13BD, West Midlands, UK.
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Fifteen-year trends of long-term disability and sick leaves in ankylosing spondylitis. Clin Rheumatol 2011; 30:361-7. [PMID: 21210289 DOI: 10.1007/s10067-010-1669-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 12/13/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
Abstract
The aim of this study is to assess the trends in work disability and sick leave in ankylosing spondylitis (AS). In 1993 and 2007, patients diagnosed with AS that attended to a secondary- or a tertiary-care outpatient rheumatology clinics were evaluated for demographics, disease characteristics, axial mobility, working status, and work days missed due to sick leave or permanent disability. Factors that impacted labor status were identified by multiple regression analysis. In 1993, 91 study individuals (mean age 35 years, mean disease duration 10 ± 8 years) included 28 (31%) on permanent disability and 63 currently working; of these 63, 42 (67%) had missed at least 1 work day in the previous 12 months (mean 69 ± 63 days). In the next 5 years, the annual permanent disability was 3%. In 2007, 185 study individuals (mean age 42, mean disease duration 12 ± 10 years) included 53 (39%) on permanent disability and 132 active workers; 35 (66%) out of the 53 began permanent disability between 1999 and 2007 (2.1% annual disability rate), and 53 (40%) out of 132 active workers missed at least 1 work day in the previous 12 months (mean 52 ± 63 days). Only age predicted disability, with 10% and 11% increases in risk per year in 1993 and 2007, respectively (hazard ratios 1.09 and 1.11, respectively; p = 0.03 for both). Although the impact of AS on work seems to decrease slightly during the last 15 years, the actual impact is still substantial. An important proportion of patients went on permanent disability in the three decades before retirement. Extrapolating these results to official data for the year 2005, we may infer that between 1.3 million and nearly 15 million working days were missed that year due to AS.
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Chen HH, Chen TJ, Chen YM, Ying-Ming C, Chen DY. Gender differences in ankylosing spondylitis-associated cumulative healthcare utilization: a population-based cohort study. Clinics (Sao Paulo) 2011; 66:251-4. [PMID: 21484042 PMCID: PMC3059876 DOI: 10.1590/s1807-59322011000200012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 11/05/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is one of the most common rheumatic diseases with gender differences in prevalence and clinical presentation. This study aimed to examine whether such gender differences are correlated with cumulative healthcare utilization in Taiwan. METHODS The National Health Insurance Research Database supplied claim records of one million individuals from 1996 to 2007. Selected cases included patients aged >16 years. Certified rheumatologists diagnosed the patients in three or more visits and gave prescriptions for AS. Multivariate adjusted logistic regression analyses were used to calculate the influence of gender on cumulative healthcare utilization associated with AS. RESULTS The study included 228 women and 636 men. After adjustment for potential confounding factors, men had more cumulative outpatient visits associated with AS (odds ratio, 1.59; 95% confidence interval, 1.13 -2.23; p = 0.008). Men also exhibited a trend for higher frequency of AS-related hospitalization (p = 0.054). CONCLUSION Men are more likely to have high cumulative AS-associated healthcare utilization than women. Further investigation of the causal factors is warranted.
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Affiliation(s)
- Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan
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Poole CD, Chambers C, Allsopp R, Currie CJ. Quality of life and health-related utility analysis of adults with moderate and severe atopic dermatitis treated with tacrolimus ointment vs. topical corticosteroids. J Eur Acad Dermatol Venereol 2010; 24:674-8. [PMID: 20565562 DOI: 10.1111/j.1468-3083.2009.03485.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to measure change in quality of life (QoL) and estimate health-related utility in adults with moderate and severe atopic dermatitis (AD) following the use of either tacrolimus ointment or topical corticosteroids. METHODS Data were analysed from a double-blind, randomized controlled trial comparing the treatment of adults with moderate and severe AD with either tacrolimus ointment or a standard corticosteroid regimen. Following randomisation, patients applied their medication twice-daily for 6 months. Monthly assessments determined response and QoL. Health-related utility (EQ5Dindex) was estimated by Monte Carlo simulation from SF-12 responses via a published mapping algorithm. RESULTS At baseline, estimated utility data were available for 926 (95%) of the intention-to-treat patients, 57% of whom had AD of moderate severity (43% severe). The mean age at baseline was 32.5 years (SD +/- 11.8), 46.2% were male, with a mean EQ5Dindex for moderate cases of 0.770 (SD +/- 0.157), and 0.665 (SD +/- 0.225) for those with severe disease (P < 0.001). Patients treated with tacrolimus ointment showed significantly greater improvement in all but one domain of the SF-36. At baseline, there was no difference in estimated utility between the two groups; however, a difference in utility in favour of tacrolimus ointment emerged after 1 month's treatment (0.849 vs. 0.820; P = 0.004). Over the 6-month study period, the mean, marginal utility difference between the study arms was 0.032 U (utility) in favour of tacrolimus (P < 0.001). CONCLUSION Treatment with 0.1% tacrolimus ointment rather than a standard topical corticosteroid ointment regimen was associated with clinically significant, incremental improvement in QoL, sustained over a 6-month period. A within-trial cost-utility estimate based on study medication cost alone suggests that tacrolimus ointment is highly cost-effective given existing willingness-to-pay thresholds.
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Affiliation(s)
- C D Poole
- Department of Epidemiology, Pharmatelligence Ltd, Cardiff, UK
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Kumar S. Need for determining the incidence and prevalence of JIA in developing countries: the Indian predicament. Rheumatology (Oxford) 2010; 49:1598-9. [DOI: 10.1093/rheumatology/keq085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Singh JA, Strand V. Health care utilization in patients with spondyloarthropathies. Rheumatology (Oxford) 2009; 48:272-6. [PMID: 19151035 DOI: 10.1093/rheumatology/ken472] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To study health care utilization in veterans with SpAs. METHODS In a postal survey of 70,508 veterans in Veterans Integrated Service Network (VISN)-13 from 1 October 1996 to 31 March 1998, demographics, smoking status and performance of activities of daily living (ADLs) were queried. Databases provided ICD-9 codes for AS, PsA and ReA; comorbidities; demographics; and health care utilization post-survey in respondents. Multivariable linear/logistic regression compared out- and inpatient health care utilization in SpA vs non-SpA, and its predictors in SpA. RESULTS A total of 1001 veteran respondents had diagnoses of SpA: AS, n = 154; PsA, n = 814; ReA, n = 33. Veterans with AS, PsA and ReA, respectively, had significantly higher adjusted annual medical specialty (2.8, 3.6 and 3 vs 1.5; P < 0.0001), surgical care (3.3, 2.7 and 3.2 vs 1.9; P < 0.0001) and primary care visits (3.4, 3.0 and 2.3 vs 2.7, P = 0.024). Multivariable-adjusted analyses showed that more ADL limitations and higher comorbidity were associated with higher in- and outpatient health care utilization in PsA and none of the predictors were significantly associated with utilization in AS. CONCLUSIONS After adjustment for differences in demographics and comorbidities, more outpatient health resource utilization was observed in SpA patients. Further studies should focus on what leads to this increase in utilization, and whether any modifiable factors can be introduced to reduce health care utilization in PsA patients.
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Affiliation(s)
- J A Singh
- Rheumatology Section, Medicine Service, VA Medical Center, Minneapolis, MN 55417, USA.
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Ariza-Ariza R, Hernández-Cruz B, López-Antequera G, Navarro-Sarabia F. Variables related to utility in patients with ankylosing spondylitis. Clin Rheumatol 2008; 28:207-11. [PMID: 18825472 DOI: 10.1007/s10067-008-1019-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 08/11/2008] [Accepted: 09/15/2008] [Indexed: 10/21/2022]
Abstract
The objective of this study was to identify variables associated to the utility of the health states in patients with ankylosing spondylitis (AS). A cross-sectional study was performed in a tertiary care centre. AS patients (New York modified criteria) were included. Demographic and disease-related variables were collected. The social tariffs of the EuroQol-5D (EQ-5D) were used to obtain utility values. Univariate and multivariate regression analyses were used in order to identify variables associated with utility. Seventy patients, 52 male (74.3%), with age (mean +/- SD) 43.7 +/- 9.1 years and disease duration 10.8 +/- 8.1 years, were included. The mean utility was 0.5625 +/- 0.3364. In the univariate analysis, patient global assessment, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) had a good correlation with the EQ-5D values (Pearson's product moment correlation coefficient r > 0.6) whereas physician global assessment, patient pain assessment, and cervical rotation had a moderate correlation with the EQ-5D (0.6 > r > 0.4). Patients with significant comorbidity had lower utility values (0.3563 +/- 0.068) than those without it (0.6796 +/- 0.041, p = 0.0001). In the multivariate analysis, BASFI and BASDAI kept an independent association with utility and they explained a 62% of the variance of the utility values. In this study, physical function and disease activity, two outcomes with good responsiveness to the treatment, were the main determinants of the utility of the health states in AS patients.
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Affiliation(s)
- Rafael Ariza-Ariza
- Rheumatology Service, Hospital Universitário Virgen Macarena, Avda Dr Fedriani, 3, 41009 Seville, Spain.
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Lundkvist J, Kastäng F, Kobelt G. The burden of rheumatoid arthritis and access to treatment: health burden and costs. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2008; 8 Suppl 2:S49-S60. [PMID: 18157732 DOI: 10.1007/s10198-007-0088-8] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
As part of the study "The burden of rheumatoid arthritis and patient access to treatment", this paper reviews evidence on the health burden of rheumatoid arthritis (RA) in terms of morbidity (DALYs), mortality (% of deaths attributable to RA) and quality of life (utility and loss of QALYs), as well as the economic impact on society. Based on available literature on the prevalence and the cost of RA, combined with economic indicators, the annual cost per patient as well as the total national cost is estimated for Europe and North America (Canada and the United States), as well as Australia, Turkey, the Russian Federation and South Africa. Total costs to society were estimated at <euro>45.3 billion in Europe and at <euro>41.6 billion in the United States. Utility scores were found to be amongst the lowest compared to other diseases.
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Abstract
Psoriatic arthritis (PsA) is a chronic autoimmune disease characterized by inflammatory arthritis in association with skin psoriasis (Ps). PsA may show a heterogeneous and variable clinical course, with involvement of peripheral and axial diarthrodial joints, periarticular structures such as entheses, as well as the skin and nails. Evidence is increasing that affected patients can have significant radiographic joint damage, functional impairment, reduced quality of life (QOL) and long-term work disability. The economic burden of PsA can be considerable. There is an increasing interest in pharmacoeconomic evaluations in PsA, driven mostly by the introduction of highly effective but expensive biologic agents, particularly inhibitors of the proinflammatory cytokine tumour necrosis factor (TNF)-alpha. Treatment with TNFalpha inhibitors results in not only substantial improvements in signs and symptoms of arthritis, but also improvements in all distinct sites of the disease, such as axial arthritis, dactylitis, enthesitis and skin disease. There is a dearth of published pharmacoeconomic evaluations in the field of PsA. The notable clinical efficacy of the TNFalpha inhibitors needs to be factored into a comprehensive assessment of their value. Further analyses are needed to optimize the use of the new biologic agents in PsA.
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Affiliation(s)
- Christoph Ackermann
- The Center for Innovative Therapy, Division of Rheumatology, Allergy and Immunology, University of California, San Diego, California 92093-0943, USA
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