title: Trends in economic consequences of rheumatoid arthritis over two subsequent years.
abstract: OBJECTIVE
  To examine changes in direct costs and in working status over 2 yrs in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  In both 1999 and 2000, RA patients (n = 461) filled out a questionnaire retrospectively regarding utilization of health care, other RA-related direct costs and working status. Patients were categorized into four disease duration groups: 0-2 yrs, 2-6 yrs, 6-10 yrs and >10 yrs. At the same time points, disease activity was assessed. Logistic regression analyses were performed to identify a possible association between disease activity (high >66th percentile) measured at start of the second year and high direct costs (high >66th percentile) in the second year.
  
  
  RESULTS
  Compared with the first year, a significant decrease in the costs for contacts with health care workers and for costs for laboratory tests was observed in the second year for the <2 yrs group. In the 2-6 yrs group and the >10 yrs group, we found a significant decrease in costs for devices and adaptations, but medication costs increased in the <2 yrs and the >10 yrs group in the second year. In the >10 yrs group, this was mainly due to an increasing number of patients who started to use biological agents during the second year. In all four disease duration groups, worse Visual Analogue Scale (VAS) disease activity and VAS general well-being were significantly associated with high direct costs. Of 97 patients working without disability at time of the first assessment, 12 (12%) patients became (partial) work disabled during follow-up.
  
  
  CONCLUSIONS
  In particular, costs for devices/adaptations and for medication changed during follow-up. The latter was probably due to an increase in the use of biological agents. Hopefully a decrease in direct costs and a reduced percentage of patients getting work disabled by better disease control will outweigh the high costs of biological drugs in the future.
authors.affiliation: University Medical Center Utrecht, The Netherlands.
authors.forename: S M M
authors.initials: SM
authors.lastname: Verstappen
authors.forename: J W G
authors.initials: JW
authors.lastname: Jacobs
authors.forename: A A
authors.initials: AA
authors.lastname: Kruize
authors.forename: J C
authors.initials: JC
authors.lastname: Ehrlich
authors.forename: G A
authors.initials: GA
authors.lastname: van Albada-Kuipers
authors.forename: H
authors.initials: H
authors.lastname: Verkleij
authors.forename: E
authors.initials: E
authors.lastname: Buskens
authors.forename: J W J
authors.initials: JW
authors.lastname: Bijlsma
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics* / Q000534:rehabilitation; D017281:Cost of Illness; D004185:Disability Evaluation; D016527:Drug Costs / Q000706:statistics & numerical data / Q000639:trends; D004651:Employment / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents