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Russell O, Lester S, Black RJ, Lassere M, Barrett C, March L, Lynch T, Buchbinder R, Hill CL. Area-Level Socioeconomic Status Impacts Health Care Visit Frequency by Australian Patients With Inflammatory Arthritis: Results From the Australian Rheumatology Association Database. Arthritis Care Res (Hoboken) 2025; 77:127-135. [PMID: 39467045 DOI: 10.1002/acr.25456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 10/11/2024] [Accepted: 10/16/2024] [Indexed: 10/30/2024]
Abstract
OBJECTIVE Individuals with inflammatory arthritis require long-term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out-of-pocket (OOP) visit costs. METHODS We linked data from Australian Rheumatology Association Database (ARAD) participants with rheumatoid arthritis or psoriatic arthritis to the Pharmaceutical Benefits (PBS) and Medicare Benefits Schedule from 2011 to 2018. Small-area SES was approximated as quintiles of the Index of Relative Socioeconomic Advantage and Disadvantage. A comorbidity index (Rx-Risk) was determined from PBS data. Analysis was performed using panel regression methods. RESULTS We included 1,916 ARAD participants (76.3% rheumatoid arthritis, 71.1% women, mean ± SD age 54 ± 12 years and disease duration 6 ± 4 years). Participants averaged 9.0 (95% confidence interval [CI] 8.6-9.4) annual GP visits and 3.9 (95% CI 3.8-4.1) annual specialist physician visits. After adjustment for sex, age, education, remoteness, and comorbidity, there was an inverse relationship between annual GP visit frequency and higher SES quintile (-0.6, 95% CI -0.9 to -0.3 visits per quintile) and a direct relationship between more frequent specialist visits and higher SES (linear slope 0.3, 95% CI 0.2-0.5 visits per quintile). Average OOP costs/visit were higher for specialist physician (AUD$38.43; 95% CI 37.34-39.53) versus GP visits (AUD$7.86; 95% CI 7.42-8.31), and higher SES was associated with greater OOP cost. CONCLUSION Patients with higher SES have relatively fewer GP visits and more specialist physician visits compared with patients with lower SES, suggesting individuals with lower SES may receive suboptimal specialist physician care. OOP costs may be a contributing factor.
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Affiliation(s)
- Oscar Russell
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and The University of Adelaide, Adelaide, South Australia, Australia
| | - Susan Lester
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel J Black
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Marissa Lassere
- St George Hospital, Kogarah, New South Wales, Australia, and University of New South Wales, Sydney, New South Wales, Australia
| | - Claire Barrett
- University of Queensland, Brisbane, Queensland, Australia
| | - Lyn March
- The University of Sydney, the Northern Sydney Local Health District, and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Tom Lynch
- The University of Sydney, the Northern Sydney Local Health District, and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Catherine L Hill
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Nikiphorou E, Nash P. Comorbidities in RA: bringing them to the limelight. Rheumatology (Oxford) 2023; 62:SI235-SI236. [PMID: 37871916 DOI: 10.1093/rheumatology/kead487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/25/2023] Open
Affiliation(s)
- Elena Nikiphorou
- Rheumatology Department, King's College Hospital and Centre for Rheumatic Diseases, King's College London, London, UK
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, QLD, Australia
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Surandran S, Ahmed S, Walton T, Nikiphorou E, Dey M. Multimorbidity in rheumatoid arthritis: common mechanistic links and impact and challenges in routine clinical practice. Rheumatology (Oxford) 2023; 62:SI260-SI270. [PMID: 37871920 DOI: 10.1093/rheumatology/kead489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 10/25/2023] Open
Abstract
Early identification and management of multimorbidity in patients with rheumatic and musculoskeletal diseases (RMDs), such as RA, is an integral, but often neglected, aspect of care. The prevalence and incidence of conditions such as osteoporosis, cardiovascular disease, pulmonary disease and malignancies, often co-existing with RA, continues to have significant implications for the management of this patient group. Multimorbidity in RMDs can be associated with inflammatory disease activity and target organ damage. Lifestyle factors, such as smoking and inactivity, further contribute to the burden of disease. Inflammation is the underlying factor, not just in RA but also many comorbidities. The current framework of a treat-to-target approach focuses on achieving early remission and inflammatory activity suppression. We describe how the comorbidity burden in people with RMDs impacts on disease outcome and treatment response. The importance of addressing comorbidity at an early stage and adopting a patient centred approach is critical in modern practice.
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Affiliation(s)
| | - Saad Ahmed
- Department of Rheumatology, Colchester General Hospital, Colchester, UK
| | - Tom Walton
- Department of Rheumatology, Colchester General Hospital, Colchester, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Rheumatology, Countless of Chester Hospital NHS Foundation Trust, Chester, UK
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4
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England BR. The Multimorbidity Web in rheumatoid arthritis. Rheumatology (Oxford) 2023; 62:SI242-SI251. [PMID: 37871922 DOI: 10.1093/rheumatology/kead246] [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: 02/27/2023] [Accepted: 05/17/2023] [Indexed: 10/25/2023] Open
Abstract
Multimorbidity, the presence of multiple chronic conditions, is highly prevalent in people with RA. An essential characteristic of multimorbidity is the interrelatedness of the different conditions that may develop in a multimorbid person. Recent studies have begun to identify and describe the Multimorbidity Web by elucidating unique multimorbidity patterns in people with RA. The primary multimorbidity patterns in this web are cardiopulmonary, cardiometabolic, and mental health and chronic pain multimorbidity. Once caught in the Multimorbidity Web, the consequences can be devastating, with reduced quality of life, physical function, survival, and treatment responses observed in multimorbid RA persons. The development of effective management and preventive approaches for multimorbidity in people with RA is in its infancy. Determining how best to assess, intervene, and prevent multimorbidity in RA is crucial to optimize long-term outcomes in people with RA.
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Affiliation(s)
- Bryant R England
- Division of Rheumatology & Immunology, Department of Internal Medicine, VA Nebraska-Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, NE, USA
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5
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Gilcrease GW, Sciascia S, Padovan D, Sciullo A, Cioffi M, Ricceri F, Radin M, Schreiber K, Husum D, Roccatello D, Nikiphorou E. Health inequalities and social determinants of health: The role of syndemics in rheumatic disease. Autoimmun Rev 2023; 22:103351. [PMID: 37121530 DOI: 10.1016/j.autrev.2023.103351] [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: 03/11/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023]
Abstract
A syndemic is the co-existence of two or more health problems (including both social and biological features) that adversely influence each other with negative consequences on disease outcomes and perpetuation of inequalities. The syndemic approach can be applied to better understand the course of rheumatic musculoskeletal diseases (RMD) involving the study of adverse biological pathways and social determinants of health (SDH) all under the same framework. Identifying if a syndemic exists within RMDs may include investigating the synergic interactions between comorbidity (e.g., diabetes, obesity, chronic kidney diseases) and the concomitant of other adverse conditions (e.g., drug non-adherence, substance abuse), along with SDHs such as low household income, unemployment, low education, limited access to health care, as well as racial/ethnic discrimination. For decades, the understanding of RMDs progression has been based on causality, rather than investigating the kaleidoscopic web of connections that can potentially influence a disease course. The co-existence of health burdens in vulnerable populations, including those with RMD, specifically in certain socioeconomic groups, calls for new ways and strategies of thinking to improve our understanding of risk factors and co-morbidities to offer tailored interventions for clinical medicine and public health policy.
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Affiliation(s)
- Gregory Winston Gilcrease
- UNESCO Chair, Department of Culture, Politics and Society, University of Turin, Italy; International Center for Sustainable Well-Being, A Project of the Center for Transformative Action, Ithaca, NY, United States of America; Rheumatology Department, King's College Hospital, London, UK
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - Dario Padovan
- UNESCO Chair, Department of Culture, Politics and Society, University of Turin, Italy
| | - Alessandro Sciullo
- UNESCO Chair, Department of Culture, Politics and Society, University of Turin, Italy
| | - Michele Cioffi
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - Fulvio Ricceri
- Center of Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Massimo Radin
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - Karen Schreiber
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark; Institute for Regional Health Research, Southern Danish University, Odense, Denmark; Thrombosis and Haemophilia, Guy's King's College and Saint Thomas' Hospitals, London, UK.
| | - Dina Husum
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - Elena Nikiphorou
- Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark; Centre for Rheumatic Diseases, King's College London, London, UK
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Madenidou AV, Mavrogeni S, Nikiphorou E. Cardiovascular Disease and Cardiac Imaging in Inflammatory Arthritis. Life (Basel) 2023; 13:life13040909. [PMID: 37109438 PMCID: PMC10143346 DOI: 10.3390/life13040909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Cardiovascular morbidity and mortality are more prevalent in inflammatory arthritis (IA) compared to the general population. Recognizing the importance of addressing this issue, the European League Against Rheumatism (EULAR) published guidelines on cardiovascular disease (CVD) risk management in IA in 2016, with plans to update going forward based on the latest emerging evidence. Herein we review the latest evidence on cardiovascular disease in IA, taking a focus on rheumatoid arthritis, psoriatic arthritis, and axial spondylarthritis, reflecting on the scale of the problem and imaging modalities to identify disease. Evidence demonstrates that both traditional CVD factors and inflammation contribute to the higher CVD burden. Whereas CVD has decreased with the newer anti-rheumatic treatments currently available, CVD continues to remain an important comorbidity in IA patients calling for prompt screening and management of CVD and related risk factors. Non-invasive cardiovascular imaging has been attracting much attention in view of the possibility of detecting cardiovascular lesions in IA accurately and promptly, even at the pre-clinical stage. We reflect on imaging modalities to screen for CVD in IA and on the important role of rheumatologists and cardiologists working closely together.
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7
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Koster F, Bakx PLH, Kok MR, Barreto DL, Weel-Koenders AEAM. Multimorbidity status and annual healthcare expenditures of rheumatoid arthritis patients: a Dutch hospital-centered versus population-based comparison. Rheumatol Int 2023; 43:1067-1076. [PMID: 36763167 PMCID: PMC10125938 DOI: 10.1007/s00296-023-05282-w] [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: 10/12/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
The prevalence of multimorbidity among rheumatoid arthritis (RA) patients is increasing and associated with worse outcomes. Therefore, management of multimorbid patients requires a multidisciplinary approach. However, healthcare systems consist of mono-disciplinary subsystems, which limits collaboration across subsystems. To study the importance of a multidisciplinary, integrated approach, associations between expenditures and multimorbidity are assessed in real-life data. Retrospective data on RA patients from a Dutch single-hospital are analyzed and compared to the Dutch RA population data. The Elixhauser index is used to measure the multimorbidity prevalence. Regression analyses were conducted to derive the relationship between multimorbidity, healthcare costs and self-reported quality of life (e.g. EQ-5D). When analyzing the impact of multimorbidity within RA patients in context of a single-hospital context, multimorbidity is only partially captured: 13% prevalence versus 24% of the Dutch population. Multimorbidity is associated with higher care expenditures. Depending on the type of multimorbidity, expenditures are €43-€5821 higher in a single-hospital and from €2259-€9648 in population data. Finally, medication use associated with chronic diseases and self-reported aspects of well-being are associated with similar increases in healthcare expenditures as multimorbidity based on hospital care. Within RA, a single-hospital approach underestimates the association between multimorbidity and healthcare expenditures as 43% of healthcare utilization and expenditures are missed. To overcome a single-provider perspective in healthcare and efficiently coordinate multimorbid patients, besides providing holistic care, professionals also need to use data providing comprehensive pictures of patients.
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Affiliation(s)
- Fiona Koster
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands. .,Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Pieter L H Bakx
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
| | - Deirisa Lopes Barreto
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
| | - Angelique E A M Weel-Koenders
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.,Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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8
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Mena-Vázquez N, Rojas-Gimenez M, Romero-Barco CM, Gandía-Martínez M, Perez-Gómez N, Godoy-Navarrete FJ, Manrique-Arija S, Garcia-Studer A, Calvo-Gutiérrez J, Varela CF, Morales-Garrido P, Pérez PC, Mouriño-Rodriguez C, Añón-Oñate I, Espildora F, Aguilar-Hurtado MC, Redondo R, Conde AH, de Los Ríos RAD, César EC, Velloso-Feijoo ML, Fernández-Nebro A. Analysis of comorbidity in rheumatoid arthritis-associated interstitial lung disease: a nested case-cohort study. Biomed Pharmacother 2023; 157:114049. [PMID: 36459713 DOI: 10.1016/j.biopha.2022.114049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/09/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To describe comorbid conditions in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to analyze factors associated with multimorbidity. METHODS Nested case-cohort study of 2 prospective cohorts: one with RA-ILD (cases) and another with RA but not ILD (controls). The cohorts were matched for age, sex, and time since diagnosis. Multimorbidity was defined as the co-occurrence of 2 or more chronic diseases, in addition to RA and ILD. We evaluated the comorbid conditions included in the Charlson Comorbidity Index, cardiovascular risk factors, neuropsychiatric conditions, and other frequent conditions in RA. We also recorded clinical-laboratory variables, inflammatory activity according to the 28-joint Disease Activity Score, C-reactive protein (CRP), physical function, and pulmonary function. We performed 2 multivariate analyses to identify factors associated with multimorbidity in RA and RA-ILD. RESULTS The final study population comprised 110 cases and 104 controls. Multimorbidity was more frequent among cases than controls (80 [72.7] vs 60 [57.7]; p = 0.021). In both groups, multimorbidity was associated with ILD (OR [95% CI] 1.92 [1.03-3.59]; p = 0.039), age (OR [95% CI] 1.05 [1.01-1.08]; p = 0.004), CRP (OR [95% CI] 1.16 [1.05-1.29]; p = 0.003), and erosions (OR [95% CI] 1.05 [1.01-1.08]; p = 0.004); in the cases, it was associated with CRP (OR [95% CI] 1.17 [1.01-1.35]; p = 0.027), anti-citrullinated peptide antibody (OR [95% CI] 1.23 [1.14-13.02]; p = 0.049), and forced vital capacity (OR [95% CI] 0.79 [0.96-0.99]; p = 0.036). CONCLUSION In patients with RA, multimorbidity was associated with ILD, systemic inflammation, and advanced age.
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Affiliation(s)
- Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain.
| | - Marta Rojas-Gimenez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Carmen María Romero-Barco
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Nair Perez-Gómez
- UGC de Reumatología, Complejo Hospitalario Universitario de Vigo, 36214 Vigo, Spain
| | | | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain; Departamento de Medicina. Universidad de Málaga, 29010 Málaga, Spain
| | - Aimara Garcia-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Jerusalem Calvo-Gutiérrez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain; UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain
| | - Clara Fuego Varela
- UGC de Reumatología, Hospital Universitario de Jerez, 11407 Cádiz, Spain
| | - Pilar Morales-Garrido
- UGC de Reumatología, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
| | | | | | | | - Francisco Espildora
- UGC de Neumología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | | | - Rocío Redondo
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Ana Hidalgo Conde
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Eva Cabrera César
- UGC Neumología, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain; Departamento de Medicina. Universidad de Málaga, 29010 Málaga, Spain
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9
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Hsieh PH, Geue C, Wu O, McIntosh E, Siebert S. How do multiple long-term conditions impact on the cost-of-illness in early rheumatoid arthritis? RMD Open 2022; 8:rmdopen-2022-002454. [PMID: 36104116 PMCID: PMC9476122 DOI: 10.1136/rmdopen-2022-002454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/20/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Multiple long-term conditions (MLTCs) are prevalent in rheumatoid arthritis (RA) and associated with worse outcomes and greater economic burden. However, little is known about the impact of MLTCs on the cost-of-illness (COI) in early RA, including direct and indirect costs. The objective of this study was to quantify this impact on COI. METHODS The Scottish Early Rheumatoid Arthritis study is a national cohort of adults with new-onset RA. Direct costs were estimated applying relevant unit costs to health resource utilisation; indirect costs were measured by productivity loss due to health conditions. Two-part models were used, adjusting for age, gender, baseline functional disability and health-related quality of life. The Charlson Comorbidity Index score was calculated using ICD-10 diagnoses. Individuals were defined as 'RA alone', 'RA plus LTC' and 'RA plus MLTCs' according to the number of coexisting LTCs. RESULTS Data were available for 818 participants. Average annualised direct costs incurred by people with early RA plus MLTCs (£4444; 95% CI £3100 to £6371) were twice as, and almost five times higher than, those with a single LTC (£2184; 95% CI £1596 to £2997) and those without LTC (£919; 95% CI £694 to £1218), respectively. Indirect costs incurred by RA plus MLTCs (£842; 95% CI £377to £1521) were 3.1 times higher than RA alone (£530; 95% CI £273to £854). The relative proportion of direct costs increased with LTC category, ranging from 77.2% to 84.1%. In addition to increased costs with LTCs, costs also increased with age and were higher for men regardless of LTC category. CONCLUSIONS MLTCs impact on COI early in the course of RA. The presence of LTCs is associated with significant increases in both direct and indirect costs among people with early RA.
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Affiliation(s)
- Ping-Hsuan Hsieh
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan .,Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- School of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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