Costs of workups for the diagnosis of early arthritis: results of a nationwide survey.
OBJECTIVE
To evaluate the costs of workups to diagnose early arthritis.


METHODS
In 2000, the French Society for Rheumatology conducted a survey of a representative sample of French and Belgian rheumatologists (n = 239). The respondents were asked to consider 2 hypothetical scenarios, 1 describing undifferentiated arthritis and the other more suggestive of rheumatoid arthritis. They were then asked what diagnostic workup they would order. Costs for each study were determined in 2001 euros, according to the French public health system fee schedules.


RESULTS
In total, 151 rheumatologists participated in the study (63%). The mean +/- SD diagnostic costs were 406.5 +/- 194.3 euro for the case with no diagnostic clues, and 280.7 +/- 154.3 euro for the case suggestive of early RA. Responses were very heterogeneous. The 2 main sources of expenditure were immunology tests and imaging. Hospital staff physicians tended to order more expensive workups, and costs tended to vary inversely with physician experience. The most important predictor of cost was diagnostic doubt, as estimated by the number of diagnoses proposed by respondents in each case; each additional diagnosis cost an additional 19.1-26.1 euro.


CONCLUSIONS
Diagnostic workups after a first medical visit for early polyarthritis result in substantial direct costs. This observation and the great variability observed in physicians' practices point out the need for consensus on the appropriate workups for these patients.
Fautrel
Bruno
B
Hospital Pitié-Salpêtrière, Paris and School of Public Health, Nancy, France. bruno.fautrel.psl.ap-hop-paris.fr
Saraux
Alain
A
Maillefert
Jean-Francis
JF
Kaye
Olivier
O
Lafforgue
Pierre
P
Flipo
René-Marc
RM
Penrod
John R
JR
Guillemin
Francis
F
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D005602:France; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012219:Rheumatology / Q000191:economics* / Q000379:methods