Gabriel S E, Crowson C S, Campion M E, O'Fallon W M
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Rheumatol. 1997 Jan;24(1):43-8.
Compared to rheumatoid arthritis (RA), osteoarthritis (OA) is considered much more benign and much less costly. We sought to describe the economic effects of RA and OA, in terms of the indirect and nonmedical expenditures, compared to nonarthritic controls.
Using our unique population based data resources, we developed a model for estimating and comparing disease specific costs among 2 randomly selected, community based samples of 200 patients each with RA and OA and a control group of 200 individuals from the same community who do not have arthritis. Data were collected using a pretested postal survey. Age and sex adjusted comparisons were conducted across the 3 groups, and predictors of cost and utilization were identified using logistic regression modeling.
There were 123, 116, and 94 respondents among the RA, OA, and nonarthritis groups, respectively. The average age and the female-to-male ratios were higher in the OA and RA groups compared to the nonarthritis group. Patients with RA and OA required 3 times more days of care for their conditions compared to nonarthritics (p < 0.0001) and incurred significantly more expenditures for home or child care (p = 0.01) and other services (p = 0.001) (i.e., medical equipment, assistive devices, or home remodeling) compared to nonarthritics. In addition, patients with RA were significantly more likely to have lost their job or to have retired early due to their illness (p = 0.001); were the most likely to have reduced their work hours or stopped working entirely due to their illness (p = 0.003); and were 3 times more likely to have had a reduction in household family income than either individuals with OA or those without arthritis (p = 0.0001). Fifteen percent of respondents with RA were unable to get a job because of their illness, while 3% of respondents with OA and only 1% of nonarthritic respondents reported this experience (p = 0.001). Logistic regression analysis revealed that functional status and pain score, as well as the presence of either RA or OA, were significant predictors of cost and health services utilization.
Disease specific indirect and nonmedical costs for OA are substantial and approach those for RA. This has important societal implications, given the high prevalence of OA.
与类风湿性关节炎（RA）相比，骨关节炎（OA）被认为危害小得多且成本低得多。我们试图描述RA和OA在间接和非医疗支出方面相对于非关节炎对照组的经济影响。
利用我们独特的基于人群的数据资源，我们开发了一个模型，用于估计和比较两个随机抽取的基于社区的样本中特定疾病的成本，每个样本包括200名RA患者、200名OA患者以及来自同一社区的200名无关节炎的对照组个体。数据通过预先测试的邮政调查收集。对三组进行年龄和性别调整后的比较，并使用逻辑回归模型确定成本和利用率的预测因素。
RA组、OA组和非关节炎组的受访者分别有123人、116人和94人。与非关节炎组相比，OA组和RA组的平均年龄和女性与男性的比例更高。与非关节炎患者相比，RA和OA患者因病情需要的护理天数多3倍（p < 0.0001），并且在家庭或儿童护理（p = 0.01）和其他服务（p = 0.001）（即医疗设备、辅助装置或房屋改造）方面的支出显著更多。此外，RA患者因疾病而失业或提前退休的可能性显著更高（p = 0.001）；因疾病而减少工作时间或完全停止工作的可能性最大（p = 0.003）；与OA患者或无关节炎患者相比，家庭收入减少的可能性高3倍（p = 0.0001）。15%的RA受访者因疾病无法找到工作，而OA受访者中有3%，非关节炎受访者中只有1%报告有此经历（p = 0.001）。逻辑回归分析表明，功能状态和疼痛评分以及RA或OA的存在是成本和卫生服务利用率的重要预测因素。
OA特定疾病的间接和非医疗成本很高，接近RA的成本。鉴于OA的高患病率，这具有重要的社会意义。
