title: Costs of ankylosing spondylitis in three European countries: the patient's perspective.
abstract: OBJECTIVE
  To assess a patient's out of pocket costs, income loss, time consumption, and quality of life (QoL) due to ankylosing spondylitis (AS) in three European countries and to assess variables predicting these outcomes.
  
  
  METHODS
  216 patients with AS from the Netherlands, France, and Belgium participated in a two year study. Health resource use, days absent from work, time lost, and quality of life (EuroQol) were assessed by bimonthly questionnaires. AS related healthcare and non-healthcare expenditure and income loss were calculated taking into account country-specific regulations. Predictors of costs, time consumption, and QoL were analysed by Cox's regression.
  
  
  RESULTS
  209 patients provided data for cost analysis. Average annual healthcare and non-healthcare expenditure was euro;431 per patient and average annual income loss was euro;1371 per patient. Healthcare costs were highest for Belgian and lowest for French patients, while non-healthcare costs were highest for Dutch patients. A patient's total costs were associated with higher age and worse physical function. On average, patients with AS needed 75 minutes additional time a day because of AS. Worse physical function and higher disease activity predicted time consumption. After adjusting for baseline confounders, QoL was worse in Belgian and French than in Dutch patients. Peripheral arthritis, worse physical function, higher disease activity, and loss of income contributed to worse QoL.
  
  
  CONCLUSIONS
  AS is time consuming and associated with substantial out of pocket costs. Belgian patients incur the highest healthcare payments. Poor physical function increases patient's costs and time consumption. Loss of income is associated with lower QoL.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, The Netherlands. aboo@sint.azm.nl
authors.forename: A
authors.initials: A
authors.lastname: Boonen
authors.forename: D
authors.initials: D
authors.lastname: van der Heijde
authors.forename: R
authors.initials: R
authors.lastname: Landewé
authors.forename: F
authors.initials: F
authors.lastname: Guillemin
authors.forename: A
authors.initials: A
authors.lastname: Spoorenberg
authors.forename: H
authors.initials: H
authors.lastname: Schouten
authors.forename: M
authors.initials: M
authors.lastname: Rutten-van Mölken
authors.forename: M
authors.initials: M
authors.lastname: Dougados
authors.forename: H
authors.initials: H
authors.lastname: Mielants
authors.forename: K
authors.initials: K
authors.lastname: de Vlam
authors.forename: H
authors.initials: H
authors.lastname: van der Tempel
authors.forename: Sj
authors.initials: S
authors.lastname: van der Linden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001530:Belgium; D017281:Cost of Illness; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D005602:France; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D011788:Quality of Life; D012943:Social Security / Q000706:statistics & numerical data; D013167:Spondylitis, Ankylosing / Q000191:economics* / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013995:Time