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Strand V, Shah R, Atzinger C, Zhou J, Clewell J, Ganguli A, Tundia N. Economic burden of fatigue or morning stiffness among patients with rheumatoid arthritis: a retrospective analysis from real-world data. Curr Med Res Opin 2020; 36:161-168. [PMID: 31433680 DOI: 10.1080/03007995.2019.1658974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Determine healthcare resource utilization (HCRU) and costs associated with fatigue and stiffness among patients with rheumatoid arthritis (RA).Methods: A retrospective claims analysis compared RA patients with fatigue or stiffness to matched RA control patients with neither. Claims from a large US commercial insurance database identified new cases of stiffness/fatigue among newly diagnosed patients. Study patients had ≥2 medical claims for RA ≥45 days apart, continuous insurance coverage ≥12 months before RA index (baseline period) and ≥12 months after fatigue/stiffness index (follow-up period). Controls had no diagnosis of fatigue or stiffness ≥12 months before index. Cases had ≥1 claim of fatigue/stiffness after RA index; the first such claim was the index date. Multivariate logistic regressions, adjusting for baseline demographics, comorbidities, medication use and HCRU, were used to predict the propensity of having a fatigue/stiffness diagnosis. Controls were propensity-score matched to cases. Generalized linear models estimated all-cause and RA-specific costs associated with resource use as well as prescription drugs, adjusting for any unbalanced covariates after propensity-score matching.Results: Approximately 32% of newly diagnosed RA patients suffer from fatigue/stiffness. Matched cohorts were analyzed: fatigue vs. control; stiffness vs. control; fatigue and stiffness vs. control. After RA diagnosis, hospitalizations increased: 83% for fatigue, 117% for stiffness and 148% for both; total office visits increased 63%, 113% and 135%, respectively. Greater HCRU yielded significantly greater (all p < .001) per-patient-per-year hospitalization costs vs. matched controls: fatigue ($2554 vs. $1293); stiffness ($2792 vs. $892); fatigue and stiffness ($3322 vs. $1033). Per-patient-per-year costs of office visits increased significantly (all p < .001) vs. matched controls: fatigue ($1373 vs. $908); stiffness ($1580 vs. $761); fatigue and stiffness ($1989 vs. $921).Conclusions: RA patients with fatigue and/or stiffness report more HCRU and incur significantly higher medical costs than RA patients without them.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
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Boers M, Buttgereit F, Saag K, Alten R, Grahn A, Storey D, Rice P, Kirwan J. What Is the Relationship Between Morning Symptoms and Measures of Disease Activity in Patients With Rheumatoid Arthritis? Arthritis Care Res (Hoboken) 2016; 67:1202-1209. [PMID: 25807939 DOI: 10.1002/acr.22592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 03/08/2015] [Accepted: 03/17/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Little is known about the relationship between morning symptoms of rheumatoid arthritis (RA) and measures of disease activity currently used to assess RA. Information available from the Circadian Administration of Prednisone in Rheumatoid Arthritis (CAPRA-2) study was used to investigate these relationships. METHODS CAPRA-2 included 350 patients with RA who were symptomatic despite treatment with disease-modifying antirheumatic drugs, randomized 2:1 to additional treatment with a 5-mg daily dose of delayed-release prednisone or placebo. Pearson's correlations were used to evaluate the relationships between change from baseline in symptoms (duration of morning stiffness, severity of morning stiffness, and intensity of pain on waking) and measures of disease activity (the American College of Rheumatology 20% improvement criteria [ACR20], the Disease Activity Score in 28 joints [DAS28], and the Health Assessment Questionnaire disability index). Correlations were defined as weak (<0.3), moderate (0.3-0.7), or strong (>0.7). RESULTS There was a strong correlation between the severity of morning stiffness and the intensity of morning pain (Pearson's correlation 0.91, P < 0.001). There was a weak correlation between the duration of morning stiffness and measures of disease activity (0.24-0.28), with moderate correlations between the severity of morning stiffness or intensity of pain on waking and DAS28 or ACR20 scores (0.44-0.48). Severity of morning stiffness showed less variability and a greater effect size than did duration of morning stiffness. CONCLUSION Morning symptoms and measures of disease activity show weak to moderate correlations. Severity of morning stiffness showed less variability and greater effect size than did duration of morning stiffness. These findings suggest that severity is the preferred construct to measure the impact of morning stiffness in patients with RA, information that is not fully captured in the RA core set.
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Affiliation(s)
- M Boers
- VU University Medical Center, Amsterdam, The Netherlands
| | | | - K Saag
- Schlosspark-Klinik, University Medicine, Berlin, Germany
| | - R Alten
- University of Alabama, Birmingham
| | - A Grahn
- Horizon Pharma, Deerfield, Illinois
| | | | - P Rice
- Premier Research, Naperville, Illinois
| | - J Kirwan
- University of Bristol, Bristol, UK
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Tuominen S, Leino M, Pirilä L, Tuominen R. Measuring the economic value of morning stiffness: consistency over 1 year. Scand J Rheumatol 2015; 45:294-8. [PMID: 26681432 DOI: 10.3109/03009742.2015.1107912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of this study were to determine the within-patient variation in the duration of morning stiffness (MS) over 1 year and the corresponding monetary equivalents assigned to its changes using the willingness-to-pay (WTP) methodology. METHOD A sample of 100 patients with rheumatoid arthritis (RA) was drawn from the register of the Hospital District of Southwest Finland. Subjects were interviewed by telephone on recruitment and 1 year later, using the same structured questionnaire. The subjects were asked to estimate in minutes the typical duration of their MS during the previous week. Sociodemographic background data and subjects' WTP for a 25, 50, 75, and 100% reduction in MS duration were requested, and years with RA diagnosis and serological data were obtained from hospital records. RESULTS After 1 year, there was a reduction in average MS duration from 44.7 min to 39.0 min (ns); duration was reduced in 35% of patients, unchanged in 35%, and prolonged in 30%. Changes in MS duration were reflected by within-patient variation in WTP estimates. In linear regression models, change in duration of MS significantly (p < 0.03) explained the variation in change of WTP for symptom reduction. CONCLUSIONS WTP methodology produces consistent monetary values to assess the relative values patients with RA place on reduction in duration of MS.
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Affiliation(s)
- S Tuominen
- a Department of Medicine, Rheumatology Unit , Turku University Hospital , Turku , Finland.,b Department of Public Health , University of Turku , Turku , Finland
| | - M Leino
- a Department of Medicine, Rheumatology Unit , Turku University Hospital , Turku , Finland.,b Department of Public Health , University of Turku , Turku , Finland
| | - L Pirilä
- a Department of Medicine, Rheumatology Unit , Turku University Hospital , Turku , Finland
| | - R Tuominen
- b Department of Public Health , University of Turku , Turku , Finland.,c Hospital District of Southwest Finland , Turku , Finland
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Gossec L, Berenbaum F, Chauvin P, Lamiraud K, Russo-Marie F, Joubert JM, Saraux A. Reporting of patient-perceived impact of rheumatoid arthritis and axial spondyloarthritis over 10 years: a systematic literature review. Rheumatology (Oxford) 2014; 53:1274-81. [PMID: 24602920 PMCID: PMC4065006 DOI: 10.1093/rheumatology/ket480] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE RA and axial SpA have an important impact on patients' lives. The objective of this study was to explore the reporting of different aspects of that impact in publications, with a focus on differences between diseases and over time. METHODS A systematic literature review retrieved all articles reporting on the life impact of RA or axial radiographic SpA in adults published within the last 10 years and issued from European research. The data were classified into physical impact (including pain, functional assessment and fatigue), psychological impact (including psychological distress and coping) and social impact (including relationships, family and social life). The number of articles published over time was analysed by linear regression. RESULTS In all, 1352 abstracts were screened and 149 publications (40,056 patients) were analysed: 129 articles (86.5%) concerned RA and 16 (10.7%) concerned axial SpA. The mean number of articles reporting on the physical aspects of impact was 11.4 (s.d. 4.8) per 2-year period, but increased more than 2-fold (from 7 articles in 2001-3 to 15 in 2010-11), in particular due to recent publications on fatigue, whereas the number of articles on psychological aspects [mean 12.4 (s.d. 4.0)] decreased markedly after 2006. Publications reporting on social aspects [mean 8.2 (s.d. 4.1)] remained globally stable. CONCLUSION In the era of biologics, there is an interest in the patient-perceived life impact of RA and axial SpA in the European literature, but the impact of RA has been the subject of greater exploration. There are clearly trends over time in the reporting of impact.
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Affiliation(s)
- Laure Gossec
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France.UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France.
| | - Francis Berenbaum
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France.UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Pierre Chauvin
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Karine Lamiraud
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France.UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Francoise Russo-Marie
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Jean-Michel Joubert
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Alain Saraux
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
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