University Hospital Maastricht, Department of Internal Medicine, Division of Rheumatology, Caphri Research Institute, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Expert Rev Pharmacoecon Outcomes Res. 2005 Apr;5(2):163-81. doi: 10.1586/14737167.5.2.163.
This article reviews the cost of illness of ankylosing spondylitis in the literature and identifies limitations of comparability of cost of illness studies. The literature was searched semisystematically for studies that aimed to assess the cost of illness of ankylosing spondylitis from the societal perspective. Studies were appraised for methods and results following a self-composed checklist. To compare the aggregated costs between the studies, adjustments for differential timing and purchasing power parities between the countries were applied. In total, 53 titles were retrieved by a MEDLINE search. Five articles reported on the costs of illness in four patient populations, one from the USA and three from Europe. All studies were prevalence studies with a bottom-up approach and reported direct and productivity costs. Patient characteristics differed with respect to sampling source, age, disease duration, presence of spondylitis-related comorbidity and employment status. Categories of resource use and costs were especially difficult to compare with regard to visits to types of healthcare providers and use of formal and informal help in relation to inability to perform unpaid work. In addition, not all studies reported the productivity costs based on human capital as well as the friction cost method. The cost per unit of resource use was only provided explicitly in one publication. Sensitivity analyses were usually not performed. Total 2002 costs based on the human capital approach varied between USD 7243 and 11,840, and productivity costs accounted for 53-73% of the total costs. Total 2002 costs based on the friction costs varied between USD 3353 and 3903, and productivity costs accounted for 15-26% of the total costs. Cost drivers of the direct costs varied among the studies. Physical functioning and/or disease activity were consistent determinants of total costs. In conclusion, between four bottom-up prevalence studies in ankylosing spondylitis from different countries, there were differences in characteristics of patients studied, inclusion of unpaid help and unpaid production loss in the costs and choice of human capital compared with the friction cost method to calculate the productivity costs. The absence of information of the unit-cost per resource hampers comparability. Overall, the ankylosing spondylitis-related costs of illness are substantial and the high costs of formal or informal help and work disability reflect the impact of the disease on physical functioning.
本文综述了文献中强直性脊柱炎的疾病经济负担，并指出了疾病经济负担研究可比性的局限性。从社会角度评估强直性脊柱炎疾病经济负担的研究进行了半系统检索。研究方法和结果采用自我编制的检查表进行评估。为了比较研究中的汇总成本，对国家间的时间差异和购买力平价进行了调整。通过 MEDLINE 搜索共检索到 53 篇标题。五项研究报告了四个患者人群的疾病经济负担，其中一项来自美国，三项来自欧洲。所有研究均为采用自下而上方法的患病率研究，报告了直接成本和生产力成本。患者特征在采样来源、年龄、疾病持续时间、存在与脊柱炎相关的合并症和就业状况方面存在差异。在无法从事无报酬工作的情况下，与医疗保健提供者类型的就诊次数、正式和非正式帮助的使用以及与无法从事无报酬工作相关的资源使用和成本类别特别难以比较。此外，并非所有研究都根据人力资本和摩擦成本法报告了生产力成本。单位资源使用的成本仅在一份出版物中明确提供。通常未进行敏感性分析。基于人力资本方法的 2002 年总成本在 7243 美元至 11840 美元之间不等，生产力成本占总成本的 53-73%。基于摩擦成本的 2002 年总成本在 3353 美元至 3903 美元之间不等，生产力成本占总成本的 15-26%。直接成本的成本驱动因素在研究之间有所不同。身体机能和/或疾病活动是总费用的一致决定因素。总之，来自不同国家的四项基于自下而上的强直性脊柱炎患病率研究中，在研究对象的患者特征、未付费帮助和未付生产损失纳入成本以及人力资本与摩擦成本法选择计算生产力成本方面存在差异。缺乏每资源单位成本的信息会影响可比性。总体而言，强直性脊柱炎的疾病经济负担是巨大的，正式或非正式帮助和工作能力丧失的高成本反映了疾病对身体机能的影响。
