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法国类风湿关节炎的治疗成本:一项针对1109例由医院风湿病专家管理的患者的多中心研究。

Costs of rheumatoid arthritis in France: a multicenter study of 1109 patients managed by hospital-based rheumatologists.

作者信息

Guillemin Francis, Durieux Stephanie, Daurès Jean-Pierre, Lafuma Antoine, Saraux Alain, Sibilia Jean, Bourgeois Pierre, Sany Jacques

机构信息

Ecole de Santé Publique, Vandoeuvre-les-Nancy, France.

出版信息

J Rheumatol. 2004 Jul;31(7):1297-304.

Abstract

OBJECTIVE

The economic impact of rheumatoid arthritis (RA) is substantial, but most studies provide cost estimates specific to a US population. We performed a cost-of-illness analysis of patients with RA for French society.

METHODS

A cross-sectional study among rheumatologists in 148 hospitals in France was conducted between November and December 2000. Data were collected on health resource consumption associated with RA (treatments, medical devices, physician visits, examinations, hospitalization, other health professional care) during the previous 12 months. Direct costs and social costs were evaluated for 1109 RA patients. The relation of costs to disease activity and severity was analyzed.

RESULTS

The annual direct cost of RA per patient was over euro4000. The costs due to hospitalizations represented around 60% of the costs. The major reason for hospitalization was acute care for RA in a rheumatic disease ward. Patients visited a physician an average of 13 times during the 12 months, 7.7 +/- 8.6 visits to an office-based physician and 5.1 +/- 4.4 visits to a hospital-based physician. Among them, 37% of patients were receiving at least one disability pension (16.7%) or sick-leave allowance (11.9%), with an estimated cost of euro7328 per patient. The mean annual budget per patient was euro2742. Medical and social costs increased in patients with severe disease (2 times), longer disease duration since diagnosis (more than double for patients with a history longer than 10 yrs vs patients with less than 2 yrs), active disease (1.4 times), and functional status (4 times more for American College of Rheumatology class IV than for class I).

CONCLUSION

Direct costs represented 59% of the total costs for patients with active RA and 57% for patients with severe RA. Social costs represented 41% of the total costs on average.

摘要

目的

类风湿关节炎(RA)的经济影响巨大,但大多数研究提供的是针对美国人群的成本估算。我们对法国社会的类风湿关节炎患者进行了疾病成本分析。

方法

2000年11月至12月间,在法国148家医院的风湿病学家中开展了一项横断面研究。收集了此前12个月内与类风湿关节炎相关的卫生资源消耗数据(治疗、医疗设备、医生诊疗、检查、住院、其他卫生专业护理)。对1109例类风湿关节炎患者的直接成本和社会成本进行了评估。分析了成本与疾病活动度和严重程度的关系。

结果

每位类风湿关节炎患者的年度直接成本超过4000欧元。住院费用约占总成本的60%。住院的主要原因是在风湿病病房接受类风湿关节炎的急性治疗。患者在12个月内平均看医生13次,其中7.7±8.6次是看门诊医生,5.1±4.4次是看住院医生。其中,37%的患者至少领取一项残疾抚恤金(16.7%)或病假津贴(11.9%),每位患者的估计成本为7328欧元。每位患者的年平均预算为2742欧元。重症患者(成本增加2倍)、自诊断以来病程较长的患者(病程超过10年的患者比病程少于2年的患者成本增加超过一倍)、疾病活动期患者(成本增加1.4倍)以及功能状态较差的患者(美国风湿病学会IV级患者的成本比I级患者高4倍)的医疗和社会成本均有所增加。

结论

活动期类风湿关节炎患者的直接成本占总成本的59%,重症类风湿关节炎患者的直接成本占总成本的57%。社会成本平均占总成本的41%。

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