title: Preliminary evaluation of medical outcomes (including quality of life) and costs in incident RA cases receiving hospital-based multidisciplinary management.
abstract: A six-month, prospective descriptive study of medical outcomes (including quality of life) and costs was conducted in 20 incident cases of rheumatoid arthritis (RA). Multidisciplinary management was started during an inpatient stay at the beginning of the study. Patients were evaluated on a day-hospital basis three and six months later. The following parameters were studied: quality-of-life scores on a generic scale (the Nottingham Health Profile [NHP]) and two specific scales (Health Assessment Questionnaire [HAQ] and the short-form Arthritis Impact Measurement Scale [AIMS]), pain severity, disease activity assessed by the patient and physician, painful and swollen joint counts, erythrocyte sedimentation rate, and C-reactive protein level. The following costs were evaluated: laboratory tests, plain radiographs, other investigations, physician care (by rheumatologists or other specialists), second-line drug therapy and monitoring for its side effects, care by nurses, physical therapy, and occupational therapy. All patients showed significant improvement three months after initiation of multidisciplinary management. This effect was sustained through the sixth month. Quality-of-life scores improved, with the exceptions of the social isolation subscore on the NHP and the psychological impact, social activity, and occupational activity subscores on the short-form AIMS. Mean total cost for the six-month period was 3429 +/- 880 euros (1 euro = 6.6 FF). Laboratory tests contributed the largest portion of the total cost (39%), followed by rheumatologist care (16%); the other costs accounted for 7.6 to 9.2% of the total cost. This prospective medical and economic study is preliminary. Comparative studies are needed.
authors.affiliation: Immuno-rheumatology Department, Lapeyronie Teaching Hospital, Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Maravic
authors.forename: M C
authors.initials: MC
authors.lastname: Bozonnat
authors.forename: A
authors.initials: A
authors.lastname: Sevezan
authors.forename: D
authors.initials: D
authors.lastname: Gasqueres
authors.forename: J
authors.initials: J
authors.lastname: Pastor
authors.forename: M
authors.initials: M
authors.lastname: Péré
authors.forename: V
authors.initials: V
authors.lastname: Neil
authors.forename: F
authors.initials: F
authors.lastname: Roch-Bras
authors.forename: J P
authors.initials: JP
authors.lastname: Daures
authors.forename: J
authors.initials: J
authors.lastname: Sany
mesh_terms: D001172:Arthritis, Rheumatoid / Q000191:economics* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005602:France; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome