workplace; osteoarthritis; direct costs; indirect costs; determinants; health related quality of life
Abstract :
[en] OBJECTIVE: To estimate the direct and indirect costs of osteoarthritis (OA) in an active population, and to identify factors significantly influencing these expenditures. METHODS: A cohort of 3,440 subjects employed by the Liege City Council was followed prospectively for 6 months. Subjects were asked to report monthly OA related health resource utilization (contacts with health professionals, medical examinations, drug consumption, etc.) and absence from work. Health related quality of life (HRQOL) was evaluated at baseline using the Medical Outcomes Study Short-form 36 (SF-36). Logistic regression analysis identified factors associated with the probability that the individual incurred costs, and multiple regression identified factors influencing the magnitude of these costs. RESULTS: A total of 1,811 subjects filled in at least one questionnaire (response rate 52%). The mean duration of followup was 3.46 months. Self-reported prevalence of OA was 34.1%. The mean total direct costs were 44.5 euros per OA patient-month. Contacts with health professionals, medical examinations, drugs, and hospital stays accounted for 23.7 euros, 8.7 euros, 6.7 euros, and 4.9 euros, respectively, per OA patient-month. The average number of sick-leave days was 0.8 per OA patient-month. From a payer's perspective, this loss of productivity represented a mean cost of 64.5 euros per OA patient-month. We also recorded 0.02 mean days off work per active subject-month due to informal care by relatives, yielding a mean cost of 1.8 euro per active subject-month for the employer. Poorer scores for most of the dimensions of the SF-36 at baseline were significantly associated with greater likelihood of incurring direct and indirect costs and with higher costs among subjects who reported costs. If we consider the overall cohort of active subjects, the burden of OA related to the direct and indirect costs was 15.2 euros and 23.8 euros, respectively, per active subject-month. CONCLUSION: Direct and indirect costs attributable to OA are substantial, with productivity related costs being predominant. Poorer HRQOL was a major determinant of these expenditures.
Disciplines :
Rheumatology
Author, co-author :
Rabenda, Véronique ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Manette, C.
Lemmens, R.
Mariani, A. M.
Struvay, N.
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Language :
English
Title :
Direct and indirect costs attributable to osteoarthritis in active subjects
Badley EM. The effect of osteoarthritis on disability and health care use in Canada. J Rheumatol 1995;22 Suppl 43:19-22.
Reginster JY. The prevalence and burden of arthritis. Rheumatology Oxford 2002;41 Suppl 1:3-6.
Reygrobellet C, le Pen C. COART France rapport 2003 sur les nouvelles données socio-économiques de l'arthrose en France. Presse Med 2004;33:1S4-1S6.
Dunlop DD, Manheim LM, Yelin EH, Song J, Chang RW. The costs of arthritis. Arthritis Rheum 2003;49:101-13.
Farooqi A, Gibson T. Prevalence of the major rheumatic disorders in the adult population of North Pakistan. Br J Rheumatol 1998;37:491-5.
Ware JE Jr, Sherbourne CD. The MOS 36-item Short-form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care 1992;30:473-83.
Ware JE Jr. The SF-36 Health Survey. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia: Lippincott-Raven; 1996:337-45.
McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994;32:40-66.
Leplege A, Ecosse E, Verdier A, Perneger TV. The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 1998;51:1013-23.
Ravazi D, Gandek B. Testing Dutch and French translations of the SF-36 Health Survey among Belgian angina patients. J Clin Epidemiol 1998;51:975-81.
Hawker G, Melfi C, Paul J, Green R, Bombardier C. Comparison of a generic (SF-36) and a disease specific (WOMAC) instrument in the measurement of outcomes after knee replacement surgery. J Rheumatol 1995;22:1193-6.
Bruyere O, Compere S, Rovati L, Giacovelli G, Deroisy R, Reginster JY. Long-term outcomes after glucosamine sulphate treatment in knee osteoarthritis: mean 5-year follow-up of patients from a previous 3-year, randomised, placebo-controlled trial [abstract]. Arthritis Rheum 2003;48 Suppl:S80.
Leardini G, Salaffi F, Caporali R, Canesi B, Rovati L, Montanelli R; Italian Group for Study of the Costs of Arthritis. Direct and indirect costs of osteoarthritis of the knee. Clin Exp Rheumatol 2004;22:699-706.
Lanes SF, Lanza LL, Radensky PW, et al. Resource utilization and cost of care for rheumatoid arthritis and osteoarthritis in a managed care setting: the importance of drug and surgery costs. Arthritis Rheum 1997;40:1475-81.
Hawker GA, Badley E, Guan J, Croxford R, Coyte P. Health system costs associated with living with osteoarthritis [abstract]. Arthritis Rheum 2004;50 Suppl:S37.
Levy E, Ferme A, Perocheau D, Bono I. Socioeconomic costs of osteoarthritis in France. Rev Rhum Ed Fr 1993;60:63S-67S.
Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005;366:726-32.
World Health Organization. Legal status of traditional medicine and complementary/alternative medicine: A worldwide review. Geneva: WHO; February 2001.
Sermeus G. Alternative health care in Belgium: an explanation of various social aspects. In: Lewith G, Aldridge D, editors. Complementary medicine in the European Community. Essex, UK: The C.W. Daniel Company; 1991:61-74.
Ethgen O, Kahler KH, Kong SX, Reginster JY, Wolfe F. The effect of health related quality of life on reported use of health care resources in patients with osteoarthritis and rheumatoid arthritis: a longitudinal analysis. J Rheumatol 2002;29:1147-55.
Lapsley HM, March LM, Tribe KL, Cross MJ, Brooks PM. Living with osteoarthritis: Patient expenditures, health status, and social impact. Arthritis Rheum 2001;45:301-6.
Liang MH, Larson M, Thompson M, et al. Costs and outcomes in rheumatoid arthritis and osteoarthritis. Arthritis Rheum 1984;27:522-9.
Heliovaara M, Aromaa A, Klaukka T, Knekt P, Joukamaa M, Impivaara O. Reliability and validity of interview data on chronic diseases. The Mini-Finland Health Survey. J Clin Epidemiol 1993;46:181-91.
Briggs A, Scott E, Steele K. Impact of osteoarthritis and analgesic treatment on quality of life of an elderly population. Ann Pharmacother 1999;33:1154-9.
de Bock GH, Kaptein AA, Touw-Otten F, Mulder JD. Health-related quality of life in patients with osteoarthritis in a family practice setting. Arthritis Care Res 1995;8:88-93.
Studney DR, Hakstian AR. A comparison of medical record with billing diagnostic information associated with ambulatory medical care. Am J Public Health 1981;71:145-9.
Yaffe R, Shapiro S, Fuchseberg RR, Rohde CA, Corpeno HC. Medical economics survey - methods study: cost-effectiveness of alternative survey strategies. Med Care 1978;16:641-59.
Goossens ME, Rutten-van Molken MP, Vlaeyen JW, van der Linden SM. The cost diary: a method to measure direct and indirect costs in cost-effectiveness research. J Clin Epidemiol 2000; 53:688-95.