Cost of Finnish statutory inpatient rehabilitation and its impact on functional and work capacity of patients with early rheumatoid arthritis: experience from the FIN-RACo trial.
OBJECTIVE
To explore the cost of the statutory inpatient rehabilitation system in Finland and its impact on the functional and work capacity of patients with early rheumatoid arthritis (RA).


METHODS
In the Finnish Rheumatoid Arthritis Combination-Therapy trial (FIN-RACo), 195 patients with recent-onset RA, 162 of them available for the work force, were randomly assigned to two different drug treatment strategies for 2 years. Otherwise, the patients received routine multidisciplinary care and, if their functional or work capacity was endangered, were referred to inpatient rehabilitation. After a 5-year follow-up, data on rehabilitation, sick leave, and RA-related disability pensions were obtained from official registers.


RESULTS
Of the 162 patients, 49 (30%) underwent inpatient rehabilitation at an average cost of EURO5400. The rehabilitated patients more often worked in white-collar jobs and had more pain and a worse Health Assessment Questionnaire (HAQ) score (1.0 vs. 0.78; p = 0.01) at baseline. Their HAQ scores remained higher throughout follow-up (p<0.001); no change appeared over inpatient periods [mean 0.01; 95% confidence interval (CI) -0.13 to 0.16]. No independent impact of rehabilitation on the HAQ score emerged in an adjusted generalized estimating equations (GEE) model (p = 0.55). Nor did any improvement in work capacity appear: average lost productivity (human capital approach) per patient-year was EURO10 155 (95% CI 6994-14 196) before and EUR 12 839 (95% CI 8589-19 139) after the start of rehabilitation.


CONCLUSIONS
For patients with recent-onset RA, the Finnish statutory inpatient rehabilitation system had no positive impact on either functional or work capacity during the first few years, despite its considerable cost.
Puolakka
K
K
Department of Medicine, Lappeenranta Central Hospital, Lappeenranta, Finland. kari.puolakka@fimnet.fi
Kautiainen
H
H
Möttönen
T
T
Hannonen
P
P
Pohjolainen
T
T
Korpela
M
M
Vuori
K
K
Ilva
K
K
Yli-Kerttula
U
U
Järvinen
P
P
Leirisalo-Repo
M
M
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D005387:Finland; D006801:Humans; D007297:Inpatients; D007596:Joints / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010415:Pensions