Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.
Scand J Rheumatol. 2022 Sep;51(5):355-362. doi: 10.1080/03009742.2021.1944306. Epub 2021 Sep 13.
To identify the patterns of healthcare resource utilization and unmet needs of persistent disease activity, pain, and physical disability in rheumatoid arthritis (RA) by cluster analysis.
Patients attending the Jyväskylä Central Hospital rheumatology unit, Finland, were, from 2007, prospectively enrolled in a clinical database. We identified all RA patients in 2010-2014 and combined their individual-level data with well-recorded administrative data on all public healthcare contacts in fiscal year 2014. We ran agglomerative hierarchical clustering (Ward's method), with 28-joint Disease Activity Score with three variables, Health Assessment Questionnaire index, pain (visual analogue scale 0-100), and total annual health service-related direct costs (€) as clustering variables.
Complete-case analysis of 939 patients derived four clusters. Cluster C1 (remission and low costs, 550 patients) comprised relatively young patients with low costs, low disease activity, and minimal disability. C2 (chronic pain, disability, and fatigue, 269 patients) included those with the highest pain and fatigue levels, and disability was fairly common. C3 (inflammation, 97 patients) had rather high mean costs and the highest average disease activity, but lower average levels of pain and less disability than C2, highlighting the impact of effective treatment. C4 (comorbidities and high costs, 23 patients) was characterized by exceptionally high costs incurred by comorbidities.
The majority of RA patients had favourable outcomes and low costs. However, a large group of patients was distinguished by chronic pain, disability, and fatigue not unambiguously linked to disease activity. The highest healthcare costs were linked to high disease activity or comorbidities.
通过聚类分析确定类风湿关节炎（RA）持续性疾病活动、疼痛和身体残疾的医疗资源利用模式和未满足的需求。
自 2007 年以来，芬兰于韦斯屈莱中央医院风湿病科的患者前瞻性地纳入临床数据库。我们于 2010-2014 年确定了所有 RA 患者，并将其个体水平数据与 2014 财年所有公共医疗保健接触的记录良好的行政数据相结合。我们采用凝聚层次聚类（Ward 法），以 28 关节疾病活动评分的三个变量（健康评估问卷指数、疼痛（视觉模拟评分 0-100）和总年度健康服务相关直接费用（€）作为聚类变量。
对 939 例患者进行完整病例分析得出 4 个聚类。集群 C1（缓解和低成本，550 例）包括成本低、疾病活动度低且残疾程度最小的相对年轻患者。C2（慢性疼痛、残疾和疲劳，269 例）包括疼痛和疲劳水平最高、残疾较为常见的患者。C3（炎症，97 例）的平均费用较高，平均疾病活动度最高，但疼痛和残疾程度低于 C2，这突出了有效治疗的影响。C4（合并症和高成本，23 例）的特点是合并症导致的费用异常高。
大多数 RA 患者的结局良好且成本较低。然而，一组患者的特征是慢性疼痛、残疾和疲劳，与疾病活动度不明确相关。最高的医疗保健费用与高疾病活动度或合并症有关。
