Huscher D, Merkesdal S, Thiele K, Zeidler H, Schneider M, Zink A
German Rheumatism Research Centre, Berlin, Germany.
Ann Rheum Dis. 2006 Sep;65(9):1175-83. doi: 10.1136/ard.2005.046367. Epub 2006 Mar 15.
To estimate and compare the direct and indirect costs of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE), and to evaluate the effect of sex, disease duration and functional status on the various cost domains.
Data of outpatients, aged 18-65, with rheumatoid arthritis (n = 4351), ankylosing spondylitis (n = 827), PsA (n = 908) or SLE (n = 844), who were enrolled in the national database of the German collaborative arthritis centres in 2002, were analysed. Data on healthcare consumption, out-of-pocket expenses and productivity losses were derived from doctors and patients. For the calculation of indirect costs, the human capital approach (HCA) and the friction cost approach (FCA) were applied.
Mean direct costs amounted to 4737 euros a year in rheumatoid arthritis, 3676 euros in ankylosing spondylitis, 3156 euros in PsA and 3191 euros in SLE. By using the HCA, total costs were calculated at 15,637 euros in rheumatoid arthritis, 13,513 euros in ankylosing spondylitis, 11,075 euros in PsA and 14,411 euros in SLE, whereas with the FCA the numbers were 7899 euros, 7204 euros, 5570 euros and 6518 euros, respectively. Costs increased with disease duration and were strongly dependent on functional status. In patients with the highest disability (<50% of full function), the total costs on applying the HCA were 34,915 euros in rheumatoid arthritis, 29,647 euros in alkylosing spondylitis, 37,440 euros in PsA and 32,296 euros in SLE.
The costs of illness are high in all four diseases, with a strong effect of functional status on total costs. Indirect costs differ by the factor 3, based on whether the HCA or the FCA is used.
评估并比较类风湿性关节炎、强直性脊柱炎、银屑病关节炎（PsA）和系统性红斑狼疮（SLE）的疾病直接成本和间接成本，并评估性别、病程和功能状态对各成本领域的影响。
分析了2002年纳入德国协作性关节炎中心国家数据库的18至65岁门诊患者的数据，其中类风湿性关节炎患者4351例、强直性脊柱炎患者827例、PsA患者908例、SLE患者844例。医疗保健消费、自付费用和生产力损失的数据来自医生和患者。计算间接成本时采用了人力资本法（HCA）和摩擦成本法（FCA）。
类风湿性关节炎的年平均直接成本为4737欧元，强直性脊柱炎为3676欧元，PsA为3156欧元，SLE为3191欧元。采用HCA计算，类风湿性关节炎的总成本为15637欧元，强直性脊柱炎为13513欧元，PsA为11075欧元，SLE为14411欧元；而采用FCA时，相应数字分别为7899欧元、7204欧元、5570欧元和6518欧元。成本随病程增加而增加，且强烈依赖于功能状态。在残疾程度最高（功能不足全功能50%）的患者中，采用HCA计算时，类风湿性关节炎的总成本为34915欧元，强直性脊柱炎为29647欧元，PsA为37440欧元，SLE为32296欧元。
所有这四种疾病的疾病成本都很高，功能状态对总成本有很大影响。根据采用的是HCA还是FCA，间接成本相差3倍。
