title: The economic burden of rheumatoid arthritis in a developing nation: results from a one-year prospective cohort study in Thailand.
abstract: OBJECTIVE
  To assess annual direct and indirect costs in a prospective cohort of patients with rheumatoid arthritis (RA) in Thailand from the societal perspective.
  
  
  METHODS
  Data on costs and intangible losses were prospectively collected at regular intervals over a one-year period from 158 RA patients who attended a major tertiary care facility in Bangkok, Thailand. Direct medical, direct nonmedical, indirect, and total costs were estimated according to patients' respective health insurance conditions and converted to 2001 US dollars using published purchasing power parity estimates. Sensitivity analyses were performed and the predictors of costs and intangible losses were investigated.
  
  
  RESULTS
  The average societal cost of RA was estimated to be 2682 US dollars, 41.4% of patients' average annual income. Average direct and indirect costs were estimated to amount to 2135 US dollars and 547 US dollars per patient per year, respectively. Seventy-three patients (46.2%) experienced at least one event of intangible losses and 46 patients (29.1%) had decreased earnings ability because of RA. Poor physical function, joint deformity, high number of disease modifying antirheumatic drugs, and steroid use contributed to higher costs and presence of intangible losses.
  
  
  CONCLUSIONS
  RA consumes a significant proportion of patients' annual average incomes and poses a significant economic burden to society. Since RA mainly affects a working-age population, early and timely treatment of this disease can improve both the suffering and the economic productivity of patients in Thailand.
authors.affiliation: Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Manathip.O@chula.ac.th
authors.forename: Manathip
authors.initials: M
authors.lastname: Osiri
authors.forename: Andreas
authors.initials: A
authors.lastname: Maetzel
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000191:economics* / Q000453:epidemiology; D015331:Cohort Studies; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008019:Life Style; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013785:Thailand / Q000453:epidemiology