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Healthcare consumption and direct costs of rheumatoid arthritis in Belgium
Authors:R Westhovens  A Boonen  L Verbruggen  P Durez  L De Clerck  M Malaise  H Mielants
Institution:(1) Department of Rheumatology, University Hospitals KU Leuven, Leuven, Belgium;(2) Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht and Caphri Research Institute, Maastricht, The Netherlands;(3) Rheumatology Unit, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium;(4) Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium;(5) Department of Clinical Immunology and Rheumatology, University Hospital Antwerp, Antwerp, Belgium;(6) Department of Rheumatology, University of Liège, Belgium;(7) Department of Rheumatology, University Hospital Gent and AZ St-Augustinus Wilrijk, Belgium;(8) Department of Rheumatology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
Abstract:The aim of this study was to compare the socioeconomic consequences of early and late rheumatoid arthritis in Belgium and to assess the patient out-of-pocket contributions. This multicentre longitudinal study in Belgium evaluated patients with rheumatoid arthritis. Early disease was defined as diagnosis since less than 1 year. At baseline sociodemographic and disease characteristics were assessed and during the following year patients recorded all healthcare- and non-healthcare-related direct costs and out-of-pocket contributions. The study included 48 patients with early and 85 patients with late rheumatoid arthritis. Mean disease duration was 0.5 vs 12.5 years in patients with early and late rheumatoid arthritis, respectively. The disease activity score (DAS28) was comparable between both groups (4.1 vs 4.5, p=0.14), but physical function (Health Assessment Questionnaire, HAQ) was more impaired in patients with long-standing disease (1.0 vs 1.7, p<0.001). Work disability had increased from 2% in patients with early to 18% in patients with late disease. The annual societal direct costs per patient were € 3055 (median: € 1518) opposed to € 9946 (median: € 4017) for early and late rheumatoid arthritis, respectively. The higher direct cost for patients with long-standing disease was seen for all categories, but especially for physiotherapy and need for devices and adaptations. Patients with early as well as late disease contribute out of pocket about one-third to the direct healthcare costs. Within each group, HAQ was a strong determinant of costs. In Belgium, patients with long-standing rheumatoid arthritis are nine times more likely to be work disabled than patients with less than 1 year disease duration and have a threefold increase in costs. Differences in healthcare consumption between patients could be mainly explained by differences in physical function (HAQ).
Keywords:Cost of illness  Rheumatoid arthritis
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