Burden of anemia in patients with osteoarthritis and rheumatoid arthritis in French secondary care.
BACKGROUND
Arthritic disorders can be the cause of hospitalizations, especially among individuals 60 years and older. The objective of this study is to investigate associations between health care resource utilization in arthritis patients with and without concomitant anemia in a secondary care setting in France.


METHODS
This retrospective cohort study utilized data on secondary care activity in 2001 from the Programme de Médicalisation des Systèmes d'Information database. Two cohorts were defined using ICD-10 codes: patients with an arthritis diagnosis with a concomitant diagnosis of anemia; and arthritis patients without anemia. Health care resource utilization for both populations was analyzed separately in public and private hospitals. Study outcomes were compared between the cohorts using standard bivariate and multivariable methods.


RESULTS
There were 300,865 hospitalizations for patients with arthritis only, and 2,744 for those with concomitant anemia. Over 70% of patients with concomitant anemia were in public hospitals, compared with 53.5% of arthritis-only patients. Arthritis patients without anemia were younger than those with concomitant anemia (mean age 66.7 vs 74.6, public hospitals; 67.1 vs 72.2, private hospitals). Patients with concomitant anemia/arthritis only had a mean length of stay of 11.91 (SD 14.07)/8.04 (SD 9.93) days in public hospitals, and 10.68 (SD 10.16)/9.83 (SD 7.76) days in private hospitals. After adjusting for confounders, the mean (95% CI) additional length of stay for arthritis patients with concomitant anemia, compared with those with arthritis only, was 1.56 (1.14-1.98) days in public and 0.69 (0.22-1.16) days in private hospitals. Costs per hospitalization were €;480 (227-734) greater for arthritis patients with anemia in public hospitals, and €;30 (-113-52) less in private hospitals, than for arthritis-only patients.


CONCLUSIONS
Arthritis patients with concomitant anemia have a longer length of stay, undergo more procedures, and have higher hospitalization costs than nonanemic arthritis patients in public hospitals in France. In private hospitals, concomitant anemia was associated with modest increases in length of stay and number of procedures; however, this did not translate into higher costs. Such evidence of anemia-related health care utilization and costs can be considered as a proxy for the clinical significance of anemia.
Zlateva
Gergana
G
Pfizer Inc, New York, NY, USA. gergana.zlateva@pfizer.com
Diazaraque
Ruth
R
Viala-Danten
Muriel
M
Niculescu
Liviu
L
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies
Ann Rheum Dis. 1996 Mar;55(3):162-8
8712878
J Gerontol A Biol Sci Med Sci. 2006 May;61(5):474-9
16720744
Arch Intern Med. 2003 Jun 23;163(12):1400-4
12824088
Value Health. 2005 Nov-Dec;8(6):629-38
16283863
Am J Med. 2003 Aug 1;115(2):104-10
12893395
Gastroenterology. 2003 Feb;124(2):288-92
12557133
J Rheumatol. 2004 Jul;31(7):1297-304
15229947
J Manag Care Pharm. 2005 Sep;11(7):565-74
16137214
Am J Health Syst Pharm. 2007 Aug 15;64(16 Suppl 11):S3-10
17687068
Rheumatol Int. 2004 Jan;24(1):14-9
12720045
BMC Geriatr. 2008 Jan 14;8:1
18194534
World Health Organ Tech Rep Ser. 2003;919:i-x, 1-218, back cover
14679827
Arthritis Rheum. 1998 May;41(5):778-99
9588729
Rheumatology (Oxford). 2000 Jan;39(1):28-33
10662870
Am J Med. 2004 Apr 5;116 Suppl 7A:50S-57S
15050886
N Engl J Med. 2002 Dec 26;347(26):2104-10
12501222
N Engl J Med. 1993 Sep 23;329(13):931-5
8361508
Curr Opin Rheumatol. 2002 Sep;14(5):573-7
12192258
J Cardiovasc Pharmacol. 2006;47 Suppl 1:S72-5
16785834
N Engl J Med. 2005 Mar 10;352(10):1011-23
15758012
Pharmacoeconomics. 2004;22(2 Suppl 1):1-12
15157000
BMJ. 1994 Nov 19;309(6965):1337-8
7866082
J Am Geriatr Soc. 2004 May;52(5):719-24
15086651
World Health Organ Tech Rep Ser. 1968;405:5-37
4975372
J Gerontol A Biol Sci Med Sci. 2005 Jun;60(6):729-35
15983175
Arthritis Rheum. 1988 Oct;31(10):1318-21
3178910
Clin Rheumatol. 1999;18(4):293-8
10468168
Rheumatology (Oxford). 2005 Dec;44(12):1531-7
16091394
Arthritis Rheum. 2008 Jan;58(1):15-25
18163481
Semin Arthritis Rheum. 1990 Feb;19(4):209-23
2181669
Br Heart J. 1993 Oct;70(4):357-62
8217445
J Rheumatol. 1997 Apr;24(4):719-25
9101508
J Am Geriatr Soc. 2005 Dec;53(12):2106-11
16398894
Br J Haematol. 1987 Aug;66(4):559-64
3663512