Leardini G, Salaffi F, Caporali R, Canesi B, Rovati L, Montanelli R
Division of Rheumatology, Venice, Italy.
Clin Exp Rheumatol. 2004 Nov-Dec;22(6):699-706.
Rheumatic diseases have an economic impact of 1-2.5% of GDP in industrialized countries and osteoarthritis is the most common joint disorder. Osteoarthritis of the knee is especially common and is a major cause of disability requiring extensive utilization of health care resources.
To estimate the burden of osteoarthritis of the knee in Italy, we studied retrospectively a cohort of 254 patients over a period of 12 months in 2000-2001.
Twenty-nine rheumatology institutes took part in the study. A bottom-up approach was used, analytically measuring pro capita consumption. We considered medical (hospitalization, diagnosis, and therapies) and non-medical costs (transport, temporary caregivers, and auxiliary devices) as direct costs. We calculated losses of productivity borne by patients and caregivers, and informal care provided by caregivers as indirect costs.
Direct costs came to Euros 934 per patient per year: Euros 233 were spent on hospitalization, Euros 209 on diagnostic procedures (56% on visits and 44% on instrumental and laboratory tests), Euros 146 on therapy (58% on physiotherapy and 42% on drugs), and Euros 346 on non-medical costs (73% on salaries to temporary caregivers, 14% on transport, and 13% on auxiliary devices). It is interesting to point out that at least 37% of costs were charged directly to patients. Indirect costs were almost 30% higher and came to Euros 1236 per patient per year: 31% was due to loss of productivity of patients, 60% due to informal care provided by primary caregivers, and 9% by other caregivers.
This study confirms that the direct and indirect costs attributable to osteoarthritis of the knee are substantial.
在工业化国家，风湿性疾病对经济的影响占国内生产总值的1%至2.5%，骨关节炎是最常见的关节疾病。膝关节骨关节炎尤为常见，是导致残疾的主要原因，需要大量使用医疗保健资源。
为了评估意大利膝关节骨关节炎的负担，我们在2000 - 2001年的12个月期间对254名患者进行了回顾性队列研究。
29个风湿病研究所参与了该研究。采用自下而上的方法，分析性地测量人均消费。我们将医疗费用（住院、诊断和治疗）和非医疗费用（交通、临时护理人员和辅助设备）视为直接成本。我们计算了患者和护理人员的生产力损失，以及护理人员提供的非正式护理作为间接成本。
每位患者每年的直接成本为934欧元：233欧元用于住院，209欧元用于诊断程序（56%用于就诊，44%用于仪器和实验室检查），146欧元用于治疗（58%用于物理治疗，42%用于药物），346欧元用于非医疗费用（73%用于临时护理人员的工资，14%用于交通，13%用于辅助设备）。有趣的是，至少37%的费用直接由患者承担。间接成本高出近30%，每位患者每年达1236欧元：31%是由于患者生产力损失，60%是由于主要护理人员提供的非正式护理，9%是由于其他护理人员。
本研究证实，膝关节骨关节炎的直接和间接成本相当可观。
