This article is part of the Arthritis Archives.
Dateline: May 23, 2000
Costs With Having Seropositive Rheumatoid Arthritis:
In various ways, the cost of having disabling arthritis is enormous. A study reported in The Journal Of Rheumatology (May 2000) offers an assessment of the direct and indirect cost in dollars and cents.Who:
A group of 150 patients with early rheumatoid arthritis (RA) participated in the study. Entry criteria for the study included:
- satisfaction of the American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.
- clinical evidence of active disease defined by the presence of at least 9 tender and 6 swollen joints, a positive rheumatoid factor, and disease duration of less than one year.
People were eliminated and not enrolled in the study if they were taking more than 10 mg. prednisone daily, or were treated with disease-modifying anti-rheumatic drugs (DMARDs), or were less than 16 years old.
What:
The assessment was done as part of the Western Regional Consortium of Practicing Rheumatologists study.
When:
The patients were enrolled in the study from March 1993 through June 1996.
Where:
The patients participating in the study were recruited through 41 rheumatologists from 26 practices in the western United States and Mexico. Three of the practices were in university medical centers and 23 were community practices.
Why:
The objective of the study was to assess the direct and indirect cost of seropositive RA (positive for rheumatoid factor) during the first year of disease
The Method Used:
Examinations, routine laboratory tests (such as erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor), plus radiographs of the hand, wrist, and foot were performed on all participants at the beginning of the study.
The study participants also completed the Stanford Health Assessment Questionnaire (HAQ) and a self-administered questionnaire used for the purpose of obtaining information about:
- demographics
- general health status
- psychosocial function
- utilization of health care services and resources
- health insurance coverage
- out-of-pocket costs
- employment status
To assess direct costs, participants were asked about medical services used during the 6-month period prior to taking the questionnaire including:
- the dosage and duration of medications
- physician visits
- other healthcare professional visits
- hospital and nursing home admissions
- medical procedures
- radiological and laboratory tests
- assistive devices
- paid assistance
- non-traditional / natural therapies
To estimate indirect costs the participants were asked to indicate the number of days in the prior 6-month period they were unable to carry out usual activities due to their arthritis.
The Study Participants:
Of the 150 study participants, there were 120 women and 30 men. The mean age of the group was 51 years and the mean disease duration was 5.9 months. Eighty seven percent of the group of participants had 12 years of education or more. At the time of enrollment for the study, the group was comprised of:
- 78 people who were employed
- 24 retirees
- 22 homemakers
- 12 disabled persons
- 5 people on sick leave
- 3 people who were described as "between jobs"
- 2 students
- 1 person on vacation
- 2 people with unspecified employment status
- 1 person whose data regarding employment was missing
Collectively the group exhibited active rheumatoid arthritis with a mean tender joint count of 24.9 (plus or minus 13.5), a swollen joint count of 20.6 (plus or minus 11.6), elevated lab markers for inflammation, and elevated subjective measures of pain and disease activity.
- There was radiographic evidence of erosive damage in 26% of the participants.
- A history of rheumatoid nodules was noted in 12% of the study participants.
- 60% had HAQ scores indicative of at least moderate disability.
- 54% reported the existence of one or more comorbid conditions.
Study Results:
What were the direct and indirect costs? Part 2 covers the study results.
