Verstappen S M M, Jacobs J W G, Kruize A A, Ehrlich J C, van Albada-Kuipers G A, Verkleij H, Buskens E, Bijlsma J W J
University Medical Center Utrecht, The Netherlands.
Rheumatology (Oxford). 2007 Jun;46(6):968-74. doi: 10.1093/rheumatology/kem018. Epub 2007 Mar 3.
To examine changes in direct costs and in working status over 2 yrs in patients with rheumatoid arthritis (RA).
In both 1999 and 2000, RA patients (n = 461) filled out a questionnaire retrospectively regarding utilization of health care, other RA-related direct costs and working status. Patients were categorized into four disease duration groups: 0-2 yrs, 2-6 yrs, 6-10 yrs and >10 yrs. At the same time points, disease activity was assessed. Logistic regression analyses were performed to identify a possible association between disease activity (high >66th percentile) measured at start of the second year and high direct costs (high >66th percentile) in the second year.
Compared with the first year, a significant decrease in the costs for contacts with health care workers and for costs for laboratory tests was observed in the second year for the <2 yrs group. In the 2-6 yrs group and the >10 yrs group, we found a significant decrease in costs for devices and adaptations, but medication costs increased in the <2 yrs and the >10 yrs group in the second year. In the >10 yrs group, this was mainly due to an increasing number of patients who started to use biological agents during the second year. In all four disease duration groups, worse Visual Analogue Scale (VAS) disease activity and VAS general well-being were significantly associated with high direct costs. Of 97 patients working without disability at time of the first assessment, 12 (12%) patients became (partial) work disabled during follow-up.
In particular, costs for devices/adaptations and for medication changed during follow-up. The latter was probably due to an increase in the use of biological agents. Hopefully a decrease in direct costs and a reduced percentage of patients getting work disabled by better disease control will outweigh the high costs of biological drugs in the future.
研究类风湿关节炎（RA）患者两年内直接成本和工作状态的变化。
1999年和2000年，RA患者（n = 461）回顾性填写了一份关于医疗保健利用情况、其他与RA相关的直接成本和工作状态的问卷。患者被分为四个病程组：0 - 2年、2 - 6年、6 - 10年和>10年。在相同时间点，评估疾病活动度。进行逻辑回归分析，以确定第二年开始时测量的疾病活动度（高>第66百分位数）与第二年高直接成本（高>第66百分位数）之间的可能关联。
与第一年相比，<2年组在第二年与医护人员接触的成本和实验室检查成本显著降低。在2 - 6年组和>10年组，我们发现设备和适应性成本显著降低，但<2年组和>10年组在第二年药物成本增加。在>10年组，这主要是由于第二年开始使用生物制剂的患者数量增加。在所有四个病程组中，较差的视觉模拟量表（VAS）疾病活动度和VAS总体健康状况与高直接成本显著相关。在首次评估时无残疾工作的97名患者中，12名（12%）患者在随访期间变为（部分）工作残疾。
特别是，随访期间设备/适应性成本和药物成本发生了变化。后者可能是由于生物制剂使用增加。希望未来通过更好地控制疾病，直接成本降低以及工作残疾患者比例降低，将超过生物药物的高成本。
