title: Living with osteoarthritis: patient expenditures, health status, and social impact.
abstract: OBJECTIVE
  To determine "out-of-pocket" expenditures related to osteoarthritis (OA) and to explore whether demographic details, health status scores (Medical Outcomes Study 36-item Short Form [SF-36] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), or perception of social effect were expenditure determinants.
  
  
  METHODS
  A prospective cohort study of community-dwelling subjects with OA completed 4 consecutive 3-month cost diaries. In addition, subjects completed the SF-36 and WOMAC at baseline and at 12 months. Social impact at baseline was collected. Four groups categorized by age and sex were compared. Patients undergoing joint replacement were excluded.
  
  
  RESULTS
  Differences in health status were defined more by age than by sex, especially for physical function. The costs to the patients were high, particularly for women, who spent more on medications and special equipment. Women also reported receiving more assistance from family and friends. Higher disease-related expenditures were associated with greater pain levels, poorer social function and mental health, and longer duration of disease. Significant independent predictors of total patient expenditures related to OA were being female and having joint stiffness.
  
  
  CONCLUSIONS
  Despite having heavily subsidized health care and access to the Pharmaceutical Benefits Scheme, out-of-pocket costs for patients with OA in Australia are considerable. Higher expenditures for patients with OA are related to more advanced disease, especially for women.
authors.affiliation: School of Health Services Management, University of New South Wales, Sydney, Australia.
authors.forename: H M
authors.initials: HM
authors.lastname: Lapsley
authors.forename: L M
authors.initials: LM
authors.lastname: March
authors.forename: K L
authors.initials: KL
authors.lastname: Tribe
authors.forename: M J
authors.initials: MJ
authors.lastname: Cross
authors.forename: P M
authors.initials: PM
authors.lastname: Brooks
mesh_terms: D000368:Aged; D005260:Female; D005102:Health Expenditures; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000191:economics / Q000503:physiopathology / Q000523:psychology; D012922:Social Change