Direct costs of ankylosing spondylitis and its determinants: an analysis among three European countries.
OBJECTIVE
To assess direct costs associated with ankylosing spondylitis (AS). To determine which variables, including country, predict costs.


METHODS
216 patients with AS from the Netherlands, France, and Belgium participated in a two year observational study and filled in bimonthly economic questionnaires. Disease related healthcare resource use was measured and direct costs were calculated from a societal perspective (true cost estimates) and from a financial perspective (country-specific tariffs). Predictors of costs were assessed using Cox's regression analysis.


RESULTS
209 patients provided sufficient data for cost analysis. Mean annual societal direct costs for each patient were euro;2640, of which 82% were direct healthcare costs. In univariate analysis costs were higher in the Netherlands than in Belgium, but this difference disappeared after adjusting for baseline differences in patients' characteristics among countries. Longer disease duration, lower education, worse physical function, and higher disease activity were predictors of costs. Mean annual direct costs from a financial perspective were euro;2122, euro;1402, and euro;941 per patient in the Netherlands, France, and Belgium, respectively. For each country, costs from a financial perspective were significantly lower than costs from a societal perspective.


CONCLUSIONS
Direct costs for AS are substantial in three European countries but not significantly different after adjusting for baseline characteristics among countries. Worse physical function and higher disease activity are important determinants of costs, suggesting better disease control might reduce the costs of AS. The difference in costs from a societal and financial perspective emphasises the importance of an economic analysis.
Boonen
A
A
Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, The Netherlands. aboo@sint.azm.nl
van der Heijde
D
D
Landewé
R
R
Guillemin
F
F
Rutten-van Mölken
M
M
Dougados
M
M
Mielants
H
H
de Vlam
K
K
van der Tempel
H
H
Boesen
S
S
Spoorenberg
A
A
Schouten
H
H
van der Linden
Sj
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics; D001530:Belgium; D017281:Cost of Illness; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000191:economics* / Q000628:therapy; D013223:Statistics as Topic; D011795:Surveys and Questionnaires
D018501:Antirheumatic Agents