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Xiang L, Graves N, Low AHL, Leung YY, Fong W, Gan WH, Gandhi M, Thumboo J. Cost of lost productivity in inflammatory arthritis and osteoarthritis in the year before and after diagnosis: An inception cohort study. Int J Rheum Dis 2024; 27:e15252. [PMID: 38982887 DOI: 10.1111/1756-185x.15252] [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: 06/02/2023] [Revised: 11/17/2023] [Accepted: 06/21/2024] [Indexed: 07/11/2024]
Abstract
AIM Existing studies on the cost of inflammatory arthritis (IA) and osteoarthritis (OA) are often cross-sectional and/or involve patients with various disease durations, thus not providing a comprehensive perspective on the cost of illness from the time of diagnosis. In this study, we therefore assessed the cost of lost productivity in an inception cohort of patients with IA and OA in the year before and after diagnosis. METHODS Employment status, monthly income, days absent from work, and presenteeism were collected at diagnosis and 1 year later to estimate the annual costs of unemployment, absenteeism, and presenteeism using human capital approach. Non-parametric bootstrapping was performed to account for the uncertainty of the estimated costs. RESULTS Compared to patients with OA (n = 64), patients with IA (n = 102, including 48 rheumatoid arthritis, 19 spondyloarthritis, 23 psoriatic arthritis, and 12 seronegative IA patients) were younger (mean age: 52.3 vs. 59.5 years) with a greater proportion receiving treatment (99.0% vs. 67.2%) and a greater decrease in presenteeism score (median: 15% vs 10%) 1 year after diagnosis. Annual costs of absenteeism and presenteeism were lower in patients with IA than those with OA both in the year before (USD566 vs. USD733 and USD8,472 vs. USD10,684, respectively) and after diagnosis (USD636 vs. USD1,035 and USD6,866 vs. USD9,362, respectively). CONCLUSION Both IA and OA impose substantial cost of lost productivity in the year before and after diagnosis. The greater improvement in productivity seen in patients with IA suggests that treatment for IA improves work productivity.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Andrea H L Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Wee-Hoe Gan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Occupational and Environmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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2
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Mounié M, Pugnet G, Savy N, Lapeyre-Mestre M, Molinier L, Costa N. Additional Costs of Polymyalgia Rheumatica With Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2018; 71:1127-1131. [PMID: 30156754 DOI: 10.1002/acr.23736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess and compare direct costs between patients with giant cell arteritis (GCA) that is associated or not associated with polymyalgia rheumatic (PMR), and to identify the additional cost drivers due to PMR. METHODS A population-based, retrospective cohort study using the French National Health Insurance System Database was conducted. Cost analysis was performed from the French health insurance perspective and direct medical and nonmedical costs were taken into account (based on 2014 costs [€]). Costs were analyzed according to different components and divided into 6-month periods to assess care consumption. Longitudinal multivariate analyses, using generalized estimating equations, were used to adjust the effect of PMR on the mean cost over time. RESULTS Analyses were performed on 100 incident patients with GCA, 54 of whom had PMR. The cumulative additional cost due to PMR was €8,801 for 3 years, and €10,532 for 5 years. The significant additional costs occurred especially during the second and third years of follow-up, amounting to €1,769 between 12 and 18 months (P = 0.02), €1,924 between 18 and 24 months (P = 0.17), €1,458 between 24 and 30 months (P = 0.08), and €1,307 between 30 and 36 months (P = 0.07). The most important cost drivers were inpatient stays, paramedic procedures, and medications. Multivariate analyses showed a significant effect of PMR on mean cost during the first 3 years of follow-up (relative risk 1.76 [95% confidence interval 1.03-2.99], P = 0.038). CONCLUSION To our knowledge, this study is the first to accurately assess the cost of PMR care in patients with GCA and to highlight that PMR is largely responsible for the high cost of GCA.
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Affiliation(s)
- Michael Mounié
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM and Université de Toulouse, Toulouse, France
| | - Grégory Pugnet
- UMR 1027 INSERM, Université de Toulouse and Service de Médecine Interne, CHU Toulouse, Toulouse, France
| | - Nicolas Savy
- Université de Toulouse and Institut Mathématiques de Toulouse, UMR 5219, CNRS, Toulouse, France
| | - Maryse Lapeyre-Mestre
- UMR 1027 INSERM, Université de Toulouse, Laboratoire de Pharmacologie Médicale et Clinique, Service de Pharmacologie Clinique, CIC 1436, CHU Toulouse, Toulouse, France
| | - Laurent Molinier
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM and Université de Toulouse, Toulouse, France
| | - Nadège Costa
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM, Toulouse, France
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3
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Husberg M, Bernfort L, Hallert E. Costs and disease activity in early rheumatoid arthritis in 1996-2000 and 2006-2011, improved outcome and shift in distribution of costs: a two-year follow-up. Scand J Rheumatol 2018; 47:378-383. [PMID: 29611446 DOI: 10.1080/03009742.2017.1420224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate changes in healthcare utilization, costs, and disease activity from 1996 to 2011 for patients with early rheumatoid arthritis (RA). METHOD Two cohorts of patients with early RA, included in 1996-1998 (T1) and 2006-2009 (T2), were followed regularly. Healthcare utilization, costs, and disease activity were compared between cohorts during 2 years after diagnosis. RESULTS Disease activity was significantly improved in T2 vs T1. Drug costs increased in T2 vs T1 (EUR 911 vs EUR 535, respectively; p = 0.017), and costs for RA-related hospitalization decreased. More than 90% in T2 were prescribed disease-modifying anti-rheumatic drugs (DMARDs) at inclusion compared to 50% in T1. At 2 year follow-up, levels were still > 90% in T2, while corresponding values in T1 were just above 70%. Comparing T2 to T1, total direct costs were slightly higher in T2 (EUR 3941 vs EUR 3364, respectively; ns), sick leave decreased (EUR 3511 vs EUR 5672; p = 0.025), while disability pension increased slightly (EUR 4889 vs EUR 4244; ns), but total indirect costs remained unchanged (EUR 8400 vs EUR 9916; ns). Total direct and indirect costs did not differ between the cohorts (EUR 12 342 in T2 vs EUR 13 280 in T1; ns), and loss of productivity still represented the largest component of total costs. CONCLUSION T2 patients were prescribed DMARDs earlier and more aggressively than T1 patients. Stable and better improvements in disease activity, function, and quality of life were achieved in T2 compared to T1. There was a shift within the components in direct costs and indirect costs, but total costs remained essentially unchanged.
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Affiliation(s)
- M Husberg
- a Center for Medical Technology Assessment, Division of Health Care Analysis , Linköping University , Linköping , Sweden
| | - L Bernfort
- a Center for Medical Technology Assessment, Division of Health Care Analysis , Linköping University , Linköping , Sweden
| | - E Hallert
- a Center for Medical Technology Assessment, Division of Health Care Analysis , Linköping University , Linköping , Sweden
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4
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Sakr BR, Elfishawi MM, ElArousy MH, Hatw AK, AbdulKarim AN, Tammam AB, Kotp AN, Hamed ME, Genedy IE, Desouky EDE, Nawito ZO. Rheumatoid arthritis: A single-center Egyptian experience. Immunol Invest 2018; 47:293-302. [DOI: 10.1080/08820139.2018.1425700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- B. R Sakr
- Rheumatology and Rehabilitation Department, Kasr Al-Ainy Hospital, Cairo University , Cairo, Egypt
| | - M. M Elfishawi
- Rheumatology and Rehabilitation Department, Kasr Al-Ainy Hospital, Cairo University , Cairo, Egypt
| | - M. H ElArousy
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - A. K Hatw
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - A. N AbdulKarim
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - A. B Tammam
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - A. N Kotp
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - M. E Hamed
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - I. E Genedy
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - E. D. El Desouky
- Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University , Cairo, Egypt
| | - Z. O. Nawito
- Rheumatology and Rehabilitation Department, Kasr Al-Ainy Hospital, Cairo University , Cairo, Egypt
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5
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Ernst FR, Barr P, Elmor R, Sandulli W, Thevathasan L, Sterman AB, Goldenberg J, Vora K. The Economic Impact of Levothyroxine Dose Adjustments: the CONTROL HE Study. Clin Drug Investig 2017; 37:71-83. [PMID: 27798756 PMCID: PMC5209418 DOI: 10.1007/s40261-016-0462-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background In general, hypothyroidism can be adequately treated with a consistent daily dose of levothyroxine. However, the need for levothyroxine dose adjustments is frequent in clinical practice. The extent to which levothyroxine dose adjustments increase the utilization of healthcare resources has not previously been described in the clinical literature. Objective The primary objective of our study was to measure the effect of levothyroxine dose adjustments in terms of their utilization of healthcare resources including direct and indirect costs. A secondary goal was to identify any differences in patient characteristics that may be responsible for levothyroxine dose adjustments. Methods A retrospective medical chart review was conducted among patients of selected healthcare providers in the USA. Patients who were recently started on levothyroxine therapy (<6 months) were excluded to avoid situations that were more likely attributable to treatment initiation than inadequate therapeutic effect. Trained nurses extracted data from patient charts and electronic medical record systems for review. We analyzed the cost of resources consumed by the frequency of levothyroxine dose changes over 24 months: 0 dose changes (no dose adjustment group); one dose change, two dose changes, three or more dose changes (≥1 dose adjustment group). Results The study included 454 patients. Overall estimated resource utilization was higher per patient in the ≥1 dose adjustment group (US$5824) vs. the no dose adjustment group (US$3166) during the 24-month study period. When direct and indirect costs were combined, overall costs of care were greatest in patients requiring three or more dose adjustments (US$8220/patient). Patients in this cohort incurred 2.5-fold greater total costs compared with patients requiring no dose adjustments (US$8220 vs. US$3166). Among the 58 patients in the group requiring three or more dose adjustments, mean direct medical costs were significantly higher than in the patients requiring no dose adjustments (US$6387 vs. US$2182). Patients with at least one dose adjustment experienced a 40.3% increase in lost productivity vs. patients who had no dose adjustments (US$1381 vs. US$984). Loss of productivity was highest among patients with three or more levothyroxine dose adjustments. Among this cohort, there was an 86.4% increase in lost productivity vs. patients who had no levothyroxine dose adjustments (US$1833 vs. US$984). Conclusions Patients experiencing multiple levothyroxine dose adjustments were shown to consume more healthcare resources, resulting in higher costs than those who required no dose adjustments. Each care episode contributed to lost time and wages with total estimated lost productivity escalating with increasing levothyroxine dose adjustments over a 24-month period. Electronic supplementary material The online version of this article (doi:10.1007/s40261-016-0462-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frank R Ernst
- Health Economics and Outcomes Research, Indegene, Inc., 222 Chastain Meadows Court, Suite 300, Kennesaw, GA, 30144, USA.
| | - Peri Barr
- Health Economics and Outcomes Research, Indegene, Inc., 222 Chastain Meadows Court, Suite 300, Kennesaw, GA, 30144, USA
| | - Riad Elmor
- Health Economics and Outcomes Research, Indegene, Inc., 222 Chastain Meadows Court, Suite 300, Kennesaw, GA, 30144, USA
| | | | - Lionel Thevathasan
- LT Associates Ltd, Paris, France
- Department of Neuroscience, University of Oxford, Oxford, UK
| | | | | | - Kevin Vora
- Akrimax Pharmaceuticals, LLC, Cranford, NJ, USA
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Migliore A, Bizzi E, Petrella L, Bruzzese V, Cassol M, Integlia D. The Challenge of Treating Early-Stage Rheumatoid Arthritis: The Contribution of Mixed Treatment Comparison to Choosing Appropriate Biologic Agents. BioDrugs 2016; 30:105-15. [PMID: 26905069 DOI: 10.1007/s40259-016-0164-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Use of biologic drugs is approved for treatment in rheumatoid arthritis (RA), both in established disease and at the early stage of RA (ERA). Identification of ERA and an early therapeutic strategy would lead to greater clinical improvement. Only a few indirect comparisons of the efficacy of different biologic agents in established RA have been performed and, to date, no studies reporting direct comparisons have been performed in ERA. OBJECTIVE The aim of this study was to compare, by use of a mixed treatment comparison (MTC), the efficacy profiles of biologic agents in ERA. METHODS An extensive literature search was performed to identify results of randomized, controlled trials (RCTs) evaluating biologic agents at licensed doses to treat patients affected by ERA. The primary end points for the analysis were the American College of Rheumatology 20% improvement (ACR20), ACR50, and ACR70 responses from baseline to various times of follow-up. WinBUGS 1.4 software (MRC Biostatistics Unit, Cambridge, UK) was used to perform the analyses. The MTC results are reported as the relative risk of a response for every single treatment coadministered with methotrexate, versus methotrexate plus placebo, which was used as a comparator in all RCTs. RESULTS Ten scientific papers met the study inclusion criteria and were included in the analysis. Data on the use of infliximab, adalimumab, etanercept, abatacept, golimumab, and rituximab were included. No studies reported on the use of certolizumab pegol or tocilizumab in ERA. All biologic agents coadministered with methotrexate proved to be more efficacious than methotrexate plus placebo in inducing ACR20, ACR50, and ACR70 responses. The biologic agent characterized by the highest probability of inducing an ACR70 response was adalimumab (33.28%). Etanercept was the biologic agent with the highest probability of inducing ACR20 and ACR50 responses, in comparison with all other biologic agents, with probability rates of 62.95 and 37.1%, respectively. CONCLUSION In our analysis, adalimumab proved to be the biologic agent with the highest probability of inducing an ACR70 response in patients affected by ERA, while etanercept was the biologic agent with the highest probability of inducing ACR50 and ACR20 responses.
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Affiliation(s)
- Alberto Migliore
- Rheumatology Department, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189, Rome, Italy.,International Society For Pharmacoeconomics and Outcomes Research (ISPOR), Rome, Italy
| | - Emanuele Bizzi
- Rheumatology Department, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189, Rome, Italy.
| | - Lea Petrella
- Methods and Models for Economics, Territory and Finance (MEMOTEF) Department, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Bruzzese
- Internal Medicine and Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Maurizio Cassol
- Internal Medicine Department, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Davide Integlia
- Integrated Solutions Health Economics and Organization (ISHEO), Rome, Italy
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Martikainen JA, Kautiainen H, Rantalaiho V, Puolakka KT. Longterm Work Productivity Costs Due to Absenteeism and Permanent Work Disability in Patients with Early Rheumatoid Arthritis: A Nationwide Register Study of 7831 Patients. J Rheumatol 2016; 43:2101-2105. [DOI: 10.3899/jrheum.160103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2016] [Indexed: 11/22/2022]
Abstract
Objective.To estimate the development and potential disproportional distribution of longterm productivity costs (PC) and their determinants leading to work absenteeism and permanent work disability in working-aged patients with early rheumatoid arthritis (RA).Methods.A cohort of subjects with early RA was created by identifying the new cases of RA from the national drug reimbursement register that had been granted a special reimbursement for their antirheumatic medications for RA from 2000–2007. The dataset was enriched by cross-linking with other national registries detailing work absenteeism days and permanent disability pensions. In the base case, the human capital approach was applied to estimate PC based on subjects’ annual number of absenteeism days and incomes. Hurdle regression analysis was applied to study the determinants of PC.Results.Among the 7831 subjects with early RA, the mean (bootstrapped 95% CI) annual PC per person-observation year was €4800 (4547–5070). The annual PC declined after the first year of RA diagnosis, but increased significantly in subsequent years. In addition, the PC was heavily disproportionally concentrated in a small fraction of patients with RA, because only around 20% of patients accounted for the majority of total annual PC. The initiation of active drug treatment during the first 3 months after RA diagnosis significantly reduced the cumulative PC when compared with no drug treatment.Conclusion.The longterm PC increased significantly in parallel with years elapsing after RA diagnosis. Further, the majority of these PC are incurred by a small proportion of patients.
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Rice DB, Mehta S, Pope JE, Harth M, Shapiro A, Teasell RW. Dispositional Affect in Unique Subgroups of Patients with Rheumatoid Arthritis. Pain Res Manag 2016; 2016:1024985. [PMID: 27445594 PMCID: PMC4904597 DOI: 10.1155/2016/1024985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/29/2015] [Indexed: 02/08/2023]
Abstract
Background. Patients with rheumatoid arthritis may experience increased negative outcomes if they exhibit specific patterns of dispositional affect. Objective. To identify subgroups of patients with rheumatoid arthritis based on dispositional affect. The secondary objective was to compare mood, pain catastrophizing, fear of pain, disability, and quality of life between subgroups. Methods. Outpatients from a rheumatology clinic were categorized into subgroups by a cluster analysis based on dispositional affect. Differences in outcomes were compared between clusters through multivariate analysis of covariance. Results. 227 patients were divided into two subgroups. Cluster 1 (n = 85) included patients reporting significantly higher scores on all dispositional variables (experiential avoidance, anxiety sensitivity, worry, fear of pain, and perfectionism; all p < 0.001) compared to patients in Cluster 2 (n = 142). Patients in Cluster 1 also reported significantly greater mood impairment, pain anxiety sensitivity, and pain catastrophizing (all p < 0.001). Clusters did not differ on quality of life or disability. Conclusions. The present study identifies a subgroup of rheumatoid arthritis patients who score significantly higher on dispositional affect and report increased mood impairment, pain anxiety sensitivity, and pain catastrophizing. Considering dispositional affect within subgroups of patients with RA may help health professionals tailor interventions for the specific stressors that these patients experience.
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Affiliation(s)
- Danielle B. Rice
- Lawson Health Research Institute, London, ON, Canada N6C 0A7
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
| | - Swati Mehta
- Lawson Health Research Institute, London, ON, Canada N6C 0A7
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
- Western University, London, ON, Canada N6A 3K7
| | - Janet E. Pope
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
- Western University, London, ON, Canada N6A 3K7
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada N6A 3K7
| | - Manfred Harth
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
- Western University, London, ON, Canada N6A 3K7
| | - Allan Shapiro
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
| | - Robert W. Teasell
- Lawson Health Research Institute, London, ON, Canada N6C 0A7
- St. Joseph's Health Care, Parkwood Institute, London, ON, Canada N6C 0A7
- Western University, London, ON, Canada N6A 3K7
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada N6A 3K7
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9
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Hallert E, Husberg M, Kalkan A, Bernfort L. Rheumatoid arthritis is still expensive in the new decade: a comparison between two early RA cohorts, diagnosed 1996–98 and 2006–09. Scand J Rheumatol 2016; 45:371-8. [DOI: 10.3109/03009742.2015.1126344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- E Hallert
- Centre for Medical Technology Assessment, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - M Husberg
- Centre for Medical Technology Assessment, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - A Kalkan
- Centre for Medical Technology Assessment, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - L Bernfort
- Centre for Medical Technology Assessment, Division of Health Care Analysis, Linköping University, Linköping, Sweden
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Kumar K, Raza K, Nightingale P, Horne R, Chapman S, Greenfield S, Gill P. Determinants of adherence to disease modifying anti-rheumatic drugs in White British and South Asian patients with rheumatoid arthritis: a cross sectional study. BMC Musculoskelet Disord 2015; 16:396. [PMID: 26714853 PMCID: PMC4696328 DOI: 10.1186/s12891-015-0831-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/25/2015] [Indexed: 12/31/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a common chronic inflammatory disease causing joint damage, disability, and reduced life expectancy. Highly effective drugs are now available for the treatment of RA. However, poor adherence to drug regimens remains a significant barrier to improving clinical outcomes in RA. Poor adherence has been shown to be linked to patients’ beliefs about medicines with a potential impact on adherence. These beliefs are reported to be different between ethnic groups. The purpose of this study was to identify potential determinants of adherence to disease modifying anti-rheumatic drugs (DMARDs) including an assessment of the influence of beliefs about medicines and satisfaction with information provided about DMARDs and compare determinants of adherence between RA patients of White British and South Asian. Methods RA patients of either White British (n = 91) or South Asian (n = 89) origin were recruited from secondary care. Data were collected via questionnaires on patients’: (1) self-reported adherence (Medication Adherence Report Scale-MARS); (2) beliefs about medicines (Beliefs about Medicines Questionnaire-BMQ); (3) illness perceptions (Illness Perceptions Questionnaire-IPQ) and (4) satisfaction with information about DMARDs (Satisfaction with Information about Medicines questionnaire-SIMS). In addition, clinical and demographic data were collected. Results The results revealed that socio-demographic factors only explained a small amount of variance in adherence whereas illness representations and treatment beliefs were more substantial in explaining non-adherence to DMARDs. Patients’ self-reported adherence was higher in White British than South Asian patients (median 28 (interquartile range 26–30) vs median 26 (interquartile range 23–30) respectively; P = 0.013, Mann–Whitney test). Patients who reported lower adherence were more dissatisfied with the information they had received about their DMARDs (P < 0.001, Spearman correlation, SIMS action and usage subscale; P < 0.001, Spearman correlation, SIMS potential problems subscale) and had more negative beliefs about their DMARDs and were related to ethnicity with South Asian patients having more negative views about medicines. Conclusions Socio-demographic factors were found to explain a small amount of variance in adherence. Illness representations and treatment beliefs were more important in explaining non-adherence to DMARDs. Clinicians managing South Asian patients with RA need to be aware that low adherence may be linked to negative beliefs about medicines and illness representations of RA.
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Affiliation(s)
- Kanta Kumar
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom. .,Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH, United Kingdom. .,University of Manchester, Faculty of Medical and Human Sciences, Manchester, M13 9PL, United Kingdom.
| | - Karim Raza
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH, United Kingdom.,Institute of Inflammation and Aging, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Peter Nightingale
- The Wolfson Building, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, United Kingdom
| | - Robert Horne
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - Sarah Chapman
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - Sheila Greenfield
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Paramjit Gill
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
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11
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Hanly JG, Thompson K, Skedgel C. The use of administrative health care databases to identify patients with rheumatoid arthritis. Open Access Rheumatol 2015; 7:69-75. [PMID: 27790047 PMCID: PMC5045118 DOI: 10.2147/oarrr.s92630] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To validate and compare the decision rules to identify rheumatoid arthritis (RA) in administrative databases. METHODS A study was performed using administrative health care data from a population of 1 million people who had access to universal health care. Information was available on hospital discharge abstracts and physician billings. RA cases in health administrative databases were matched 1:4 by age and sex to randomly selected controls without inflammatory arthritis. Seven case definitions were applied to identify RA cases in the health administrative data, and their performance was compared with the diagnosis by a rheumatologist. The validation study was conducted on a sample of individuals with administrative data who received a rheumatologist consultation at the Arthritis Center of Nova Scotia. RESULTS We identified 535 RA cases and 2,140 non-RA, noninflammatory arthritis controls. Using the rheumatologist's diagnosis as the gold standard, the overall accuracy of the case definitions for RA cases varied between 68.9% and 82.9% with a kappa statistic between 0.26 and 0.53. The sensitivity and specificity varied from 20.7% to 94.8% and 62.5% to 98.5%, respectively. In a reference population of 1 million, the estimated annual number of incident cases of RA was between 176 and 1,610 and the annual number of prevalent cases was between 1,384 and 5,722. CONCLUSION The accuracy of case definitions for the identification of RA cases from rheumatology clinics using administrative health care databases is variable when compared to a rheumatologist's assessment. This should be considered when comparing results across studies. This variability may also be used as an advantage in different study designs, depending on the relative importance of sensitivity and specificity for identifying the population of interest to the research question.
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Affiliation(s)
- John G Hanly
- Division of Rheumatology, Department of Medicine; Department of Pathology
| | - Kara Thompson
- Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University
| | - Chris Skedgel
- Atlantic Clinical Cancer Research Unit, Capital Health, Halifax, Nova Scotia, Canada
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Paid expenditures and productivity costs associated with permanent disability pensions in patients with spinal disorders: Nationwide Finnish Register-based Study, 1990-2010. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:275-281. [PMID: 25632839 DOI: 10.1007/s00586-015-3775-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 01/06/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The objective of this study is to present the paid expenditures and productivity costs of disability pensions (DP) due to spinal disorders (SD) in Finland during 1990-2010. METHODS This study is a register-based national study. All new cases aged 20-64 that were granted a DP due to SD were identified from the nationwide register maintained by the Finnish Centre of Pensions. The data included sex, age group, year of the DP decision, main cause of incapacity (diagnosis) leading to permanent DP and yearly paid expenditures for DPs. Annual productivity costs were estimated based on labour force participation rate and the employment rate adjusted gross domestic product. RESULTS A total of 39,107 individuals (18,072 females, 21,035 males) received DPs during the study period. SDs generated 9,372 million euros extra cost during this period due to DP (females 3.5 billion, males 5.9 billion). The total DP expenditures paid increased during the first half of 1990s but decreased during the second half of 1990s (-44.8 %). For degenerative SD cases, the DP expenditure was 5.1 billion €, disc disease 3.5 billion € and for other SDs 0.7 billion €. Males, compared to females, were expected to have a rate 1.22 times greater costs due to DPs. The estimated total annual productivity costs due to SDs have been over six times higher than expenditures paid for DPs per year. The costs of DPs are different compared to occurrence rates due to salary and early retirement age differences between genders. CONCLUSION Despite a significant decrease in DP-associated expenditures due to SDs after 1993, the annual expenditures have stayed on a high level in Finland.
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease which, if left untreated, leads to functional disability, pain, reduced health-related quality of life and premature mortality. Between 0.5% and 1% of the population are affected worldwide, and between 25 and 50 new cases evolve in a population of 100,000. Practically all patients with RA require initiation with disease-modifying antirheumatic treatment to retard or stop progression, control disease manifestations and reduce the disease burden. If disease course is monitored with adjustment of medication, lifestyle factors, and exercise, as well as physical activity levels, co-morbidities may be prevented in the course of RA. During the last decade, major progress has been made in treating RA through early identification and treatment of the disease. Many patients still experience premature work disability and co-morbidities. For societies, the economic burden of RA is high in terms of direct and indirect costs, including modern drug treatment.
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Affiliation(s)
- Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway,
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Tanaka T, Hishitani Y, Ogata A. Monoclonal antibodies in rheumatoid arthritis: comparative effectiveness of tocilizumab with tumor necrosis factor inhibitors. Biologics 2014; 8:141-53. [PMID: 24741293 PMCID: PMC3984066 DOI: 10.2147/btt.s37509] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent joint inflammation, systemic inflammation, and immunological abnormalities. Because cytokines such as tumor necrosis factor (TNF)-α and interleukin (IL)-6 play a major role in the development of RA, their targeting could constitute a reasonable novel therapeutic strategy for treating RA. Indeed, worldwide clinical trials of TNF inhibiting biologic disease modifying antirheumatic drugs (bDMARDs) including infliximab, adalimumab, golimumab, certolizumab pegol, and etanercept as well as the humanized anti-human IL-6 receptor antibody, tocilizumab, have demonstrated outstanding clinical efficacy and tolerable safety profiles, resulting in worldwide approval for using these bDMARDs to treat moderate to severe active RA in patients with an inadequate response to synthetic disease modifying antirheumatic drugs (sDMARDs). Although bDMARDs have elicited to a paradigm shift in the treatment of RA due to the prominent efficacy that had not been previously achieved by sDMARDs, a substantial percentage of patients failed primary or secondary responses to bDMARD therapy. Because RA is a heterogeneous disease in which TNF-α and IL-6 play overlapping but distinct pathological roles, further studies are required to determine the best use of TNF inhibitors and tocilizumab in individual RA patients.
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Affiliation(s)
- Toshio Tanaka
- Department of Clinical Application of Biologics, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan ; Department of Immunopathology, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Yoshihiro Hishitani
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsushi Ogata
- Department of Immunopathology, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan ; Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
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