1
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Zhang Y, Zheng P, Chen M. Sociodemographic and health system factors associated with variations in hospitalization costs for rheumatic diseases in adults aged 45 years and older: A cross-sectional study of provincial health accounts in Jiangsu Province, China. Int J Rheum Dis 2024; 27:e15241. [PMID: 38939950 DOI: 10.1111/1756-185x.15241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/11/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
AIM To report the cost of hospitalization and the associated risk factors for rheumatic diseases in middle-aged and elderly patients in China. METHODS The study participants included inpatients from hospitals of various levels in the Jiangsu Province Health Account database in 2016. Participants were selected by using a multistage sampling method. Patients <45 years of age were excluded, and patients hospitalized for rheumatic diseases were identified according to the 10th edition of the International Classification of Diseases. Generalized linear models were used to analyze the sociodemographic characteristics related to the hospitalization costs of patients with rheumatic diseases. RESULTS The study included 3696 patients. The average cost of hospitalization for patients with rheumatic diseases was USD 4038.63. Female sex, a long length of stay, age between 65 and 74 years, free medical care, not being covered by the Urban-Rural Residents Basic Medical Insurance, and a high hospital level were associated with high hospitalization costs. CONCLUSION This study examined hospitalization costs and relevant influencing factors in middle-aged and elderly patients with rheumatic disease in China. Our findings are useful for further research on costs of disease and the economic evaluation of strategies to prevent rheumatic disease.
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Affiliation(s)
- Yuan Zhang
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Peiyao Zheng
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
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2
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van der Kraan YM, Paap D, Lennips N, Veenstra ECA, Wink FR, Kieskamp SC, Spoorenberg A. Patients' Needs Concerning Patient Education in Axial Spondyloarthritis: A Qualitative Study. Rheumatol Ther 2023; 10:1349-1368. [PMID: 37523038 PMCID: PMC10469151 DOI: 10.1007/s40744-023-00585-7] [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: 05/15/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Within the EULAR recommendations, patient education (PE) is stated as the basis of the management of axial spondyloarthritis (axSpA). However, educational needs are scarcely qualitatively studied in axSpA. Therefore, we aimed to explore experiences and needs of PE in patients with axSpA. METHODS A phenomenological approach was used, with semi-structured in-depth interviews with patients with axSpA including broad variation in characteristics. Thematic analysis was applied. To enhance credibility, data saturation, research triangulation, peer debriefing, member checking, theoretical notes, and bracketing were performed. RESULTS Three interrelated themes regarding PE were identified from 20 interviews: illness perception, content, and 'availability'. Illness perception affects how patients experience and process PE, which consequently influences coping strategies. Prognosis, treatment, and coaching to self-management were identified as the most important content of PE. Regarding 'availability', face-to-face PE is preferred for exploring needs, supplemented by self-education, which can be freely applied. Additionally, sufficient time and a comprehensible amount of information were important and participants emphasized the need for axSpA-tailored information for relatives and friends. Participants reported a trusting patient-healthcare provider (HCP) relationship, and multidisciplinary and interdisciplinary attunement between HCPs as prerequisites for effective PE. CONCLUSIONS This first qualitative study exploring patients' experiences and needs of PE in axSpA revealed that prognosis, treatment, and coaching to self-management are important regarding content, and the combination of face-to-face contact and self-education the preferred modalities. It seems essential that patients' illness perceptions are taken into account for effective PE. These results add relevant insights for future PE guidelines in axSpA.
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Affiliation(s)
- Yvonne M van der Kraan
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - Davy Paap
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
- Department of Physiotherapy, School of Health, Saxion University of Applied Sciences, 7513 AB, Enschede, The Netherlands
| | - Niels Lennips
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Else C A Veenstra
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Freke R Wink
- Department of Rheumatology, Medical Center Leeuwarden, 8934 AD, Leeuwarden, The Netherlands
| | - Stan C Kieskamp
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
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3
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Mars N, Kerola AM, Kauppi MJ, Pirinen M, Elonheimo O, Sokka-Isler T. Cluster analysis identifies unmet healthcare needs among patients with rheumatoid arthritis. Scand J Rheumatol 2021; 51:355-362. [PMID: 34511040 DOI: 10.1080/03009742.2021.1944306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To identify the patterns of healthcare resource utilization and unmet needs of persistent disease activity, pain, and physical disability in rheumatoid arthritis (RA) by cluster analysis.Method: Patients attending the Jyväskylä Central Hospital rheumatology unit, Finland, were, from 2007, prospectively enrolled in a clinical database. We identified all RA patients in 2010-2014 and combined their individual-level data with well-recorded administrative data on all public healthcare contacts in fiscal year 2014. We ran agglomerative hierarchical clustering (Ward's method), with 28-joint Disease Activity Score with three variables, Health Assessment Questionnaire index, pain (visual analogue scale 0-100), and total annual health service-related direct costs (€) as clustering variables.Results: Complete-case analysis of 939 patients derived four clusters. Cluster C1 (remission and low costs, 550 patients) comprised relatively young patients with low costs, low disease activity, and minimal disability. C2 (chronic pain, disability, and fatigue, 269 patients) included those with the highest pain and fatigue levels, and disability was fairly common. C3 (inflammation, 97 patients) had rather high mean costs and the highest average disease activity, but lower average levels of pain and less disability than C2, highlighting the impact of effective treatment. C4 (comorbidities and high costs, 23 patients) was characterized by exceptionally high costs incurred by comorbidities.Conclusions: The majority of RA patients had favourable outcomes and low costs. However, a large group of patients was distinguished by chronic pain, disability, and fatigue not unambiguously linked to disease activity. The highest healthcare costs were linked to high disease activity or comorbidities.
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Affiliation(s)
- N Mars
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - A M Kerola
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - M J Kauppi
- Department of Internal Medicine, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland.,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - M Pirinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - O Elonheimo
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - T Sokka-Isler
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland
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4
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Song Y, Chen H. More economic evaluations are needed in calculating the burden of wound care. Int Wound J 2020; 17:1541-1542. [DOI: 10.1111/iwj.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yi‐Ping Song
- School of Medicine Nantong University Nantong Jiangsu China
| | - Hong‐Lin Chen
- School of Public Health Nantong University Nantong Jiangsu China
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5
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Putrik P, Ramiro S, Chorus AM, Keszei AP, Boonen A. Socio-economic gradients in the presence of musculoskeletal and other chronic diseases: results from a cross-sectional study in the Netherlands. Clin Rheumatol 2018; 37:3173-3182. [PMID: 29948350 DOI: 10.1007/s10067-018-4158-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022]
Abstract
Socio-economic gradients in occurrence of diseases have been reported for many chronic conditions. However, whether the magnitude of socio-economic gradients differs across diseases and the extent to which lifestyle mediates such relationships are not known. Cross-sectional data from The National Monitor on Musculoskeletal System was used. Respondents (> 18 years) completed a questionnaire including gender, education, social status, lifestyle, and physician-diagnosed diseases. Logistic regressions investigated the relationship between education and the major chronic diseases (musculoskeletal diseases (MSKD), diabetes, cardiovascular (CVD), cancer, mental, respiratory, any disease). Next, analyses were repeated in individuals with potential to have paid work (i.e., those < 65 having paid work, being unemployed, or receiving living allowance (minimum income)). The mediating role of smoking and BMI between education and occurrence of diseases was assessed by testing indirect effects. From 8904 individuals (mean age 54 years, 46% male), 4378 (49%) had at least one disease. Gradients in occurrence of disease by education were present for all diseases except cancer and mental disease, with the strongest gradient in diabetes (OR 2.0 [95%CI 1.4;2.8]). Unemployment and especially living on minimum income were associated with increased odds to have MSKD and mental and respiratory disease, after adjusting for education. Smoking and obesity mediated part of the relationship between education and disease, with obesity playing more pronounced role. Association between deprivation and occurrence of all major chronic diseases is of comparable magnitude, with education having most consistent contribution. Our results support the notion of the generic (i.e., non-disease specific) mechanisms underlying socio-economic gradients in health.
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Affiliation(s)
- P Putrik
- Internal Medicine/Rheumatology, Maastricht University Medical Center, MUMC+ Secretariaat Reumatologie Niveau 5, Postbus 5800, 6202 AZ, Maastricht, The Netherlands.
| | - S Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - A M Chorus
- Sector Health Care, National Health Care Institute, Diemen, The Netherlands
| | - A P Keszei
- Department of Medical Informatics Uniklinik RWTH Aachen University, Aachen, Germany
| | - A Boonen
- Internal Medicine/Rheumatology, Maastricht University Medical Center, MUMC+ Secretariaat Reumatologie Niveau 5, Postbus 5800, 6202 AZ, Maastricht, The Netherlands
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6
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O'Shea F, Taylor PC, Dickie G, Yaworsky A, Banderas B, Kachroo S. Quality of Care in Rheumatoid Disease from the Clinician Perspective: A Modified Delphi Panel Approach. Rheumatol Ther 2018; 5:87-98. [PMID: 29616498 DOI: 10.1007/s40744-018-0107-5] [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] [Received: 02/14/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION To establish clinical consensus on important and relevant quality-of-care (QoC) attributes in rheumatic disease (RD) treatment that may improve treatment outcomes and guide best practices. METHODS Twenty-three QoC attributes were identified in a literature review. Fifteen European-based clinicians were selected based on their contributions to RD guidelines, publications, and patient care. A three-round (an interview round and two web-based rounds) modified Delphi panel was conducted to reach consensus and finalize a QoC attribute list. RESULTS In round 1 (clinician interviews), clinicians reported 52 unique QoC attributes across 14 themes, with the greatest number of attributes reported in the "treatment goals" (n = 7) and "remote monitoring" (n = 7) themes. During rounds 2 and 3, the critically important QoC attributes most frequently reported were access to care/treatment (n = 14, 93.3%), safety of treatment (round 2 n = 14, 93.3%, round 3 n = 13, 86.7%), and access to clinicians and specialists (round 2: n = 13, 86.7%, round 3: n = 14, 93.3%). The final list contained 53 QoC attributes. CONCLUSION The study demonstrates consensus across several themes of QoC. Quality of care is a complex, multidimensional, and fluid concept that can be improved by ensuring patients have access to care, open communication between patients and clinicians, and the use of novel strategies, such as remote monitoring. Utilization of the attribute list can potentially improve the lives of patients, provide clinicians with tools to provide greater QoC, and improve the healthcare system as a whole. FUNDING Merck & Co., Inc.
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Affiliation(s)
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | | | | | | | - Sumesh Kachroo
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
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7
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Ter Wee MM, Coupé VM, den Uyl D, Blomjous BS, Kooijmans E, Kerstens PJ, Nurmohamed MT, van Schaardenburg D, Voskuyl AE, Boers M, Lems WF. Cost-utility of COBRA-light versus COBRA therapy in patients with early rheumatoid arthritis: the COBRA-light trial. RMD Open 2017; 3:e000502. [PMID: 29119006 PMCID: PMC5663254 DOI: 10.1136/rmdopen-2017-000502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/31/2017] [Accepted: 09/11/2017] [Indexed: 11/04/2022] Open
Abstract
Objective To evaluate if COmbinatie therapie Bij Reumatoïde Artritis (COBRA)-light therapy is cost-effective in treating patients with early rheumatoid arthritis (RA) compared with COBRA therapy. Methods This economic evaluation was performed next to the open-label, randomised non-inferiority COBRA-light trial in 164 patients with early RA. Non-responders to COBRA or COBRA-light received etanercept (50 mg/week) for 3-6 months. The societal perspective analysis took medical direct, non-medical direct and indirect costs into account. Costs were measured with patient cost diaries for the follow-up period of 52 weeks. Bootstrapping techniques estimated uncertainty around the cost-effectiveness ratios, presented in cost-effectiveness planes. Results 164 patients were randomised to either COBRA or COBRA-light strategy. At week 52, COBRA-light proved to be non-inferior to COBRA therapy on all clinical outcome measures. The results of the base-case cost-utility analysis (intention-to-treat analyses) revealed that COBRA-light strategy is more expensive (k€9.3 (SD 0.9) compared with COBRA (k€7.2 (SD 0.8)), but the difference in costs were not significant (k€2.0; 95% CI -0.3 to 4.4). Also, both strategies produced similar quality-adjusted life-years (QALYs). The sensitivity analyses showed robustness of these results. In a per-protocol sensitivity analysis, in which costs of etanercept were assumed to be provided as prescribed according to protocol, both arms had much higher costs: COBRA-light: k€11.5 (8.3) compared with k€8.5 (6.8) for COBRA, and the difference in costs was significant (k€2.9; 0.6 to 5.3). Conclusions In the base-case cost-utility analysis, the two strategies produced similar QALYs for similar costs. But it is anticipated that if protocol had been followed correctly, the COBRA-light strategy would have been more costly due to additional etanercept costs, for a limited health gain. Given the limited added benefit and high costs of starting etanercept in the presence of low disease activity in our trial, such a strategy needs better justification than is available now. Trial registration number 55552928, Results.
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Affiliation(s)
- Marieke M Ter Wee
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Veerle Mh Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Debby den Uyl
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, The Netherlands
| | - Birgit S Blomjous
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, The Netherlands
| | - Esmee Kooijmans
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Mike T Nurmohamed
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Centre, Reade, Amsterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Centre, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | - Alexandre E Voskuyl
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, The Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem F Lems
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Centre, Reade, Amsterdam, The Netherlands
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8
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De Socio A, Perrotta FM, Grasso GM, Lubrano E. Incidence of rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica in an inland area of central Italy: results of the CAMPO-RHE study. Postgrad Med 2017; 130:137-141. [PMID: 29088976 DOI: 10.1080/00325481.2018.1399774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Antonia De Socio
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, Italy
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, Italy
| | - Guido Maria Grasso
- Hygiene and Epidemiology, Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, Italy
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, Italy
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9
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van der Zee-Neuen A, Putrik P, Ramiro S, Keszei A, de Bie R, Chorus A, Boonen A. Work outcome in persons with musculoskeletal diseases: comparison with other chronic diseases & the role of musculoskeletal diseases in multimorbidity. BMC Musculoskelet Disord 2017; 18:10. [PMID: 28069020 PMCID: PMC5223391 DOI: 10.1186/s12891-016-1365-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/13/2016] [Indexed: 11/12/2022] Open
Abstract
Background Chronic diseases and multimorbidity are increasingly common among persons in working age. This study explores the impact of type, number and combinations of chronic diseases with focus on the role of MSKD on (1) adverse work status (i.e. work disability (WD), economic unemployment (UE) or receiving a living allowance (LA)) and on (2) the occurrence of sick leave. Methods Subjects participating in a Dutch household survey, who were ≤65 years and could have paid work, provided data on socio-demographics and nine physician diagnosed chronic diseases. To explore the independent association of each chronic disease, of multimorbidity and of MSKD in context of multimorbidity with 1) work status (employed, WD, LA, UE) and 2) sick leave (SL) in those employed, multinomial logistic regressions and logistic regressions were used, respectively. Results Among 5396 subjects, MSKD was the most common morbidity (17%), multimorbidity occurred in 755/5396 (14%), 436/755 (61%) of subjects with multimorbidity had an MSKD. For MSKD the odds of WD, LA and UE were 2.06 [95% CI 1.56;2.71], 2.15[1.18;3.91] and 1.35[0.94;1.96], respectively, compared to being employed and the odds of SL in MSKD were 2.29[1.92;2.73]. Mental diseases had a stronger impact on all these outcomes. The odds for adverse work outcomes increased strongly with an increasing number of diseases. When an MSKD was part of multimorbidity, an additional impact on the association with WD and SL was observed. Conclusions Multimorbidity has a stronger impact on all work outcomes compared to single chronic diseases. The presence of the MSKD in the context of multimorbidity amplifies the chance of WD or SL. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1365-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antje van der Zee-Neuen
- Internal Medicine/Rheumatology, CAPHRI, Maastricht University Medical Centre, Maastricht University, NL-6202 AZ MAASTRICHT, P/O 5800, Maastricht, Netherlands.
| | - Polina Putrik
- Internal Medicine/Rheumatology, CAPHRI, Maastricht University Medical Centre, Maastricht University, NL-6202 AZ MAASTRICHT, P/O 5800, Maastricht, Netherlands.,Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands.,Rheumatology, Hospital Garcia de Orta, Almada, Portugal
| | - Andras Keszei
- Department of Medical Informatics Uniklinik RWTH, Aachen University, Aachen, Germany
| | - Rob de Bie
- Internal Medicine/Rheumatology, CAPHRI, Maastricht University Medical Centre, Maastricht University, NL-6202 AZ MAASTRICHT, P/O 5800, Maastricht, Netherlands
| | - Astrid Chorus
- Netherlands Organization for Applied Scientific Research, Lifestyle, Leiden, Netherlands
| | - Annelies Boonen
- Internal Medicine/Rheumatology, CAPHRI, Maastricht University Medical Centre, Maastricht University, NL-6202 AZ MAASTRICHT, P/O 5800, Maastricht, Netherlands
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10
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Cuperus N, van den Hout WB, Hoogeboom TJ, van den Hoogen FHJ, Vliet Vlieland TPM, van den Ende CHM. Cost-Utility and Cost-Effectiveness Analyses of Face-to-Face Versus Telephone-Based Nonpharmacologic Multidisciplinary Treatments for Patients With Generalized Osteoarthritis. Arthritis Care Res (Hoboken) 2016; 68:502-10. [PMID: 26314289 DOI: 10.1002/acr.22709] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/13/2015] [Accepted: 08/18/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate, from a societal perspective, the cost utility and cost effectiveness of a nonpharmacologic face-to-face treatment program compared with a telephone-based treatment program for patients with generalized osteoarthritis (GOA). METHODS An economic evaluation was carried out alongside a randomized clinical trial involving 147 patients with GOA. Program costs were estimated from time registrations. One-year medical and nonmedical costs were estimated using cost questionnaires. Quality-adjusted life years (QALYs) were estimated using the EuroQol (EQ) classification system, EQ rating scale, and the Short Form 6D (SF-6D). Daily function was measured using the Health Assessment Questionnaire (HAQ) disability index (DI). Cost and QALY/effect differences were analyzed using multilevel regression analysis and cost-effectiveness acceptability curves. RESULTS Medical costs of the face-to-face treatment and telephone-based treatment were estimated at €387 and €252, respectively. The difference in total societal costs was nonsignificantly in favor of the face-to-face program (difference €708; 95% confidence interval [95% CI] -€5,058, €3,642). QALYs were similar for both groups according to the EQ, but were significantly in favor of the face-to-face group, according to the SF-6D (difference 0.022 [95% CI 0.000, 0.045]). Daily function was similar according to the HAQ DI. Since both societal costs and QALYs/effects were in favor of the face-to-face program, the economic assessment favored this program, regardless of society's willingness to pay. There was a 65-90% chance that the face-to-face program had better cost utility and a 60-70% chance of being cost effective. CONCLUSION This economic evaluation from a societal perspective showed that a nonpharmacologic, face-to-face treatment program for patients with GOA was likely to be cost effective, relative to a telephone-based program.
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11
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Lo TKT, Parkinson L, Cunich M, Byles J. Cost of arthritis: a systematic review of methodologies used for direct costs. Expert Rev Pharmacoecon Outcomes Res 2015; 16:51-65. [PMID: 26618446 DOI: 10.1586/14737167.2016.1126513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A substantial amount of healthcare and costs are attributable to arthritis, which is a very common chronic disease. This paper presents the results of a systematic review of arthritis cost studies published from 2008 to 2013. MEDLINE, Embase, EconLit databases were searched, as well as governmental and nongovernmental organization websites. Seventy-one reports met the inclusion/exclusion criteria, and 24 studies were included in the review. Among these studies, common methods included the use of individual-level data, bottom-up costing approach, use of both an arthritis group and a control group to enable incremental cost computation of the disease, and use of regression methods such as generalized linear models and ordinary least squares regression to control for confounding variables. Estimates of the healthcare cost of arthritis varied considerably across the studies depending on the study methods, the form of arthritis and the population studied. In the USA, for example, the estimated healthcare cost of arthritis ranged from $1862 to $14,021 per person, per year. The reviewed study methods have strengths, weaknesses and potential improvements in relation to estimating the cost of disease, which are outlined in this paper. Caution must be exercised when these methods are applied to cost estimation and monitoring of the economic burden of arthritis.
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Affiliation(s)
- T K T Lo
- a Research Centre for Gender, Health and Ageing , The University of Newcastle , Callaghan , Australia
| | - Lynne Parkinson
- b Central Queensland University , School of Human Health and Social Sciences , Rockhampton , Australia
| | - Michelle Cunich
- c Faculty of Pharmacy , Charles Perkins Centre, The University of Sydney , Camperdown , Australia.,d School of Medicine and Public Health, Faculty of Health and Medicine , The University of Newcastle , Callaghan , Australia
| | - Julie Byles
- a Research Centre for Gender, Health and Ageing , The University of Newcastle , Callaghan , Australia
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12
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Lo T, Parkinson L, Cunich M, Byles J. A 6-year trend of the healthcare costs of arthritis in a population-based cohort of older women. Expert Rev Pharmacoecon Outcomes Res 2015; 16:383-91. [PMID: 26523846 DOI: 10.1586/14737167.2016.1096199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To provide an accurate representation of the economic burden of arthritis by estimating the adjusted incremental healthcare cost of arthritis at multiple percentiles and reporting the cost trends across time. METHODS A healthcare cost study based on health survey and linked administrative data, where costs were estimated from the government's perspective in dollars per person per year. Quantile regression was used to estimate the adjusted incremental cost at the 25th, 50th, 75th, 90th, and 95th percentiles. RESULTS Data from 4287 older Australian women were included. The median incremental healthcare cost of arthritis was, in 2012 Australian dollars, $480 (95% CI: $498-759) in 2009; however, 5% of individuals had 5-times higher costs than the 'average individual' with arthritis. Healthcare cost of arthritis did not increase significantly from 2003 to 2009. CONCLUSION Healthcare cost of arthritis represents a substantial burden for the governments. Future research should continue to monitor the economic burden of arthritis.
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Affiliation(s)
- Tkt Lo
- a 1 Research Centre for Gender, Health and Ageing, HMRI, C/- University Drive, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Lynne Parkinson
- b 2 Central Queensland University, School of Human Health and Social Sciences, Rockhampton, QLD 4701, Australia
| | - Michelle Cunich
- c 3 Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.,d 4 The University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Callaghan NSW 2308, Australia
| | - Julie Byles
- a 1 Research Centre for Gender, Health and Ageing, HMRI, C/- University Drive, University of Newcastle, Callaghan, NSW 2308, Australia
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Putrik P, Ramiro S, Chorus AM, Keszei AP, Boonen A. Socioeconomic inequities in perceived health among patients with musculoskeletal disorders compared with other chronic disorders: results from a cross-sectional Dutch study. RMD Open 2015; 1:e000045. [PMID: 26535136 PMCID: PMC4612684 DOI: 10.1136/rmdopen-2014-000045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore the impact of socioeconomic factors on physical and mental health of patients with musculoskeletal disorders (MSKDs) and compare it across patients with other disorders. METHODS A representative sample of the Dutch population (n=8904) completed a survey on sociodemographics, physician-diagnosed (co-) morbidities, and physical (physical component summary, PCS) and mental (mental component summary, MCS) subscales of SF-12 (outcome variables). Regression models were computed first in the total group of patients with MSKDs, with education, age, gender, origin and place of residence as independent variables, and, second, in individuals expected to have paid work, adding a variable on social status. Models were repeated for five other subgroups of chronic disorders (cardiovascular (CVD), diabetes, cancer, mental and respiratory) and for healthy individuals. RESULTS MSKDs confirmed by a physician were reported by 1766 (20%) participants (mean age 59 years, 38% male), 547 (6%) respondents reported to have diabetes, 1855 (21%) CVD, 270 (3%) cancer, 526 (6%) mental disorders, 679 (8%) respiratory disorders and 4525 (51%) did not report any disease. In patients with MSKDs, (primary school vs university education (-5.3 (PCS) and -3.3 (MCS)) and having a state subsidy vs paid work (-5.3 (PCS) and -4.7 (MCS)) were consistently associated with worse physical and mental health. Gender was only relevant for PCS (female vs male -2.1). Comparable differences in health by education and social status were observed in the other diseases, except for cancer. CONCLUSIONS Education and social status in MSKD have the same strong and independent association with health as in other chronic diseases. These health gradients are unfair and partly avoidable, and require consorted attention and action in and outside healthcare.
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Affiliation(s)
- P Putrik
- Department of Rheumatology, Maastricht University Medical Center, CAPHRI School for Public Health and Primary care, Maastricht, The Netherlands
- Department of Health Promotion, Maastricht University, CAPHRI School for Public Health and Primary care, Maastricht, The Netherlands
| | - S Ramiro
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
- Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal
| | - A M Chorus
- Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands
| | - A P Keszei
- Department of Medical Informatics, Uniklinik RWTH Aachen University, Aachen, Germany
| | - A Boonen
- Department of Rheumatology, Maastricht University Medical Center, CAPHRI School for Public Health and Primary care, Maastricht, The Netherlands
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