title: Quality-of-life assessment in rheumatoid arthritis.
abstract: Rheumatoid arthritis (RA) is a chronic and lifelong autoimmune disorder that results in significant pain, disability and excess mortality if untreated or inadequately treated. Quality-of-life (QOL) assessments are particularly important in the absence of a cure for RA. Generic and disease-specific patient-reported QOL instruments, such as the Health Assessment Questionnaire (HAQ) Disability Index and the SF-36, have proven validity and sensitivity for assessment of changes in QOL in clinical trials of disease-modifying anti-rheumatic drugs (DMARDs). However, these instruments are rarely utilized in clinical practice, and patients have reported that the actual clinical assessments alone do not address important parameters, such as fatigue and disturbed sleep, which significantly affect QOL.New biological DMARDs have shown significant efficacy in improving clinical and QOL parameters in randomized controlled trials. However, the high cost of biological DMARDs compared with non-biological DMARDs is a factor in the increasing health costs associated with the treatment of RA. Generic health utility instruments that measure QOL parameters enable calculation of the increased QALYs associated with more costly treatment in patients with RA. The costs per QALY associated with biological DMARDs in RA appear to be comparable to those of other accepted medical interventions. Interest in incorporating QOL parameters in formulary and public health decision making concerning the use of new agents for RA is increasing.
authors.affiliation: Rheumatic Disease Unit, Heritage Medical Research Centre, University of Alberta, Edmonton, Alberta, Canada. as.russell@ualberta.ca
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Russell
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D002986:Clinical Trials as Topic; D006305:Health Status Indicators; D006801:Humans; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents
references.citation: Qual Life Res. 2005 Mar;14(2):285-95
references.pmid: 15892420
references.citation: Health Policy. 1996 Jul;37(1):53-72
references.pmid: 10158943
references.citation: Semin Oncol. 2002 Feb;29(1S2):2-9
references.pmid: 28140087
references.citation: Ann Rheum Dis. 2002 Nov;61(11):986-93
references.pmid: 12379521
references.citation: Med Care. 2003 Jul;41(7):791-801
references.pmid: 12835603
references.citation: Mayo Clin Proc. 2002 Apr;77(4):371-83
references.pmid: 11936935
references.citation: Adv Ther. 2006 Mar-Apr;23(2):208-17
references.pmid: 16751154
references.citation: J Rheumatol. 2006 Apr;33(4):665-70
references.pmid: 16568506
references.citation: Rheumatology (Oxford). 2006 Oct;45(10):1238-46
references.pmid: 16567357
references.citation: J Rheumatol. 1993 Mar;20(3):557-60
references.pmid: 8478873
references.citation: Expert Opin Drug Saf. 2005 Mar;4(2):149-55
references.pmid: 15794709
references.citation: Drugs. 2005;65(4):473-96
references.pmid: 15733011
references.citation: Arthritis Rheum. 1995 Jun;38(6):727-35
references.pmid: 7779114
references.citation: Rheumatol Int. 2006 May;26(7):655-62
references.pmid: 16184384
references.citation: Rheumatology (Oxford). 2004 Jun;43(6):712-8
references.pmid: 15039494
references.citation: Arthritis Rheum. 1980 Feb;23(2):137-45
references.pmid: 7362664
references.citation: Rheumatology (Oxford). 2000 Jun;39 Suppl 1:17-23
references.pmid: 11001375
references.citation: Am J Manag Care. 2002 Sep;8(9):811-20
references.pmid: 12234022
references.citation: J Rheumatol. 2002 Jan;29(1):62-7
references.pmid: 11824973
references.citation: J Gen Intern Med. 1994 Oct;9(10):576-82
references.pmid: 7823230
references.citation: Arthritis Rheum. 2005 Aug;52(8):2263-71
references.pmid: 16052582
references.citation: Rheumatol Int. 2007 May;27(7):661-6
references.pmid: 17195065
references.citation: Arthritis Rheum. 2004 Apr;50(4):1051-65
references.pmid: 15077287
references.citation: Rheumatology (Oxford). 2006 Jan;45(1):66-71
references.pmid: 16263782
references.citation: Med Care. 1993 Mar;31(3):247-63
references.pmid: 8450681
references.citation: Arthritis Rheum. 2000 Oct;43(10):2316-27
references.pmid: 11037892
references.citation: Best Pract Res Clin Rheumatol. 2006 Oct;20(5):849-63
references.pmid: 16980210
references.citation: Rheumatology (Oxford). 2002 Jun;41(6):638-42
references.pmid: 12048289
references.citation: Control Clin Trials. 1989 Dec;10(4):407-15
references.pmid: 2691207
references.citation: Med Care. 2004 Nov;42(11):1125-31
references.pmid: 15586840
references.citation: J Rheumatol. 2006 Apr;33(4):681-9
references.pmid: 16568505
references.citation: Pharmacoeconomics. 2000 Jan;17(1):13-35
references.pmid: 10747763
references.citation: Rheumatology (Oxford). 2003 May;42 Suppl 2:ii22-8
references.pmid: 12817092
references.citation: Soc Sci Med. 1995 Nov;41(10):1403-9
references.pmid: 8560308
references.citation: J Rheumatol. 2003 May;30(5):941-7
references.pmid: 12734886
references.citation: Rheumatology (Oxford). 2006 Sep;45(9):1121-4
references.pmid: 16510526
references.citation: N Engl J Med. 2005 Sep 15;353(11):1114-23
references.pmid: 16162882
references.citation: Arthritis Rheum. 2002 Feb;46(2):328-46
references.pmid: 11840435
references.citation: Arthritis Rheum. 2003 Aug 15;49(4):574-84
references.pmid: 12910566
references.citation: Arthritis Rheum. 1992 Jan;35(1):1-10
references.pmid: 1731806
references.citation: Br J Rheumatol. 1997 Aug;36(8):878-83
references.pmid: 9291857
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: Pharmacoeconomics. 1994 Dec;6(6):513-22
references.pmid: 10155281
references.citation: J Manag Care Pharm. 2006 Sep;12(7):555-69
references.pmid: 16981801
references.citation: J Gen Intern Med. 1998 Oct;13(10):664-9
references.pmid: 9798812
references.citation: Clin Exp Rheumatol. 2004 Sep-Oct;22(5 Suppl 35):S65-70
references.pmid: 15552517
references.citation: J Health Econ. 2002 Mar;21(2):271-92
references.pmid: 11939242
references.citation: Ann Rheum Dis. 2007 Feb;66(2):189-94
references.pmid: 16984942
references.citation: Arthritis Rheum. 2000 Jul;43(7):1478-87
references.pmid: 10902749
references.citation: Arthritis Rheum. 2006 Sep;54(9):2793-806
references.pmid: 16947627
references.citation: J Rheumatol. 2003 Apr;30(4):886-90
references.pmid: 12672223
references.citation: Am J Manag Care. 2002 Mar;8(3):231-40
references.pmid: 11915973
references.citation: Curr Opin Rheumatol. 2002 Mar;14(2):121-6
references.pmid: 11845016
references.citation: Health Policy. 1990 Dec;16(3):199-208
references.pmid: 10109801
references.citation: Pharmacoeconomics. 2002;20(7):463-73
references.pmid: 12093302
references.citation: J Rheumatol. 1997 Sep;24(9):1697-702
references.pmid: 9292790
references.citation: Postgrad Med. 1998 Feb;103(2):103-6, 110, 116-8 passim
references.pmid: 9479310
references.citation: Health Qual Life Outcomes. 2003 Oct 16;1:54
references.pmid: 14613568
references.citation: Health Qual Life Outcomes. 2003 Jun 09;1:20
references.pmid: 12831398
references.citation: Pharmacoeconomics. 2004;22(2 Suppl 1):27-38
references.pmid: 15157002
references.citation: Arthritis Rheum. 2006 Feb;54(2):613-20
references.pmid: 16447239
references.citation: Expert Rev Pharmacoecon Outcomes Res. 2005 Aug;5(4):395-410
references.pmid: 19807258
references.citation: J Rheumatol. 2003 Apr;30(4):639-41
references.pmid: 12672177
references.citation: Scand J Rheumatol. 2005 Sep-Oct;34(5):333-41
references.pmid: 16234180
references.citation: Rheumatology (Oxford). 2007 Apr;46(4):626-30
references.pmid: 17189244
references.citation: Ann Rheum Dis. 2006 Mar;65(3):328-34
references.pmid: 16079172
references.citation: Arthritis Res Ther. 2007;9(5):R103
references.pmid: 17922913
references.citation: Rheumatol Int. 2003 Jan;23(1):21-6
references.pmid: 12548438
references.citation: Med Care. 2002 Feb;40(2):113-28
references.pmid: 11802084