title: Perceived work ability, quality of life, and fatigue in patients with rheumatoid arthritis after a 6-month course of TNF inhibitors: prospective intervention study and partial economic evaluation.
abstract: OBJECTIVE
  The objective of this exploratory study was to evaluate the effects and costs of a 6-month course of tumour necrosis factor (TNF) inhibitors on work ability, quality of life, and fatigue in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  In this prospective single-arm intervention study 59 consecutive patients of working age with established RA were recruited from an outpatient clinic in Amsterdam, the Netherlands. All patients received fortnightly subcutaneous injections of 40 mg adalimumab. The three outcomes at baseline and 6 months were: perceived work ability [Work Ability Index (WAI)], quality of life [Rheumatoid Arthritis Quality of Life instrument (RAQoL)], and fatigue [Checklist Individual Strength (CIS), Need for Recovery (NFR) scale]. Cost data of the preceding 6 months were collected using a self-administered patient questionnaire at baseline and follow-up.
  
  
  RESULTS
  At 6 months, all outcomes showed a statistically significant improvement in mean scores from baseline, ranging from 10.0% (WAI), to 11.7% (RAQoL), to 15% (NFR) (subgroup paid work, n = 26). The total mean costs showed a twofold increase in mean costs per week per patient [difference EUR 169, 95% confidence interval (CI) EUR 113-226].
  
  
  CONCLUSIONS
  In this short-term exploratory evaluation, a 6-month course of TNF inhibitors improved work ability and quality of life, and reduced fatigue in patients with established RA. These effects are associated with an increase in total healthcare costs, attributable to the costs of TNF inhibitors. Randomized controlled trials with a longer follow-up are needed to show a long-term effect on work disability and the potential cost-effectiveness of TNF inhibitors.
authors.affiliation: Coronel Institute of Occupational Health and Research Centre for Insurance Medicine, Academic Medical Centre, University of Amsterdam, the Netherlands. j.l.hoving@amc.uva.nl
authors.forename: J L
authors.initials: JL
authors.lastname: Hoving
authors.forename: G M
authors.initials: GM
authors.lastname: Bartelds
authors.forename: J K
authors.initials: JK
authors.lastname: Sluiter
authors.forename: K
authors.initials: K
authors.lastname: Sadiraj
authors.forename: I
authors.initials: I
authors.lastname: Groot
authors.forename: W F
authors.initials: WF
authors.lastname: Lems
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: C A
authors.initials: CA
authors.lastname: Wijbrandts
authors.forename: P P
authors.initials: PP
authors.lastname: Tak
authors.forename: M T
authors.initials: MT
authors.lastname: Nurmohamed
authors.forename: A E
authors.initials: AE
authors.lastname: Voskuyl
authors.forename: M H W
authors.initials: MH
authors.lastname: Frings-Dresen