title: 28-Joint count disease activity score at 3 months after diagnosis of early rheumatoid arthritis is strongly associated with direct and indirect costs over the following 4 years: the Swedish TIRA project.
abstract: OBJECTIVE
  To explore possible association between disease activity at 3-month follow-up after RA diagnosis and costs over the following 4 years.
  
  
  METHODS
  Three-hundred and twenty patients with early (≤ 1 year) RA were assessed at regular intervals. Clinical and laboratory data were collected and patients reported health-care utilization and number of days lost from work. At 3-month follow-up, patients were divided into two groups according to disease activity, using DAS-28 with a cut-off level at 3.2. Direct and indirect costs and EuroQol-5D over the following 4 years were compared between the groups. Multivariate regression models were used to control for possible covariates.
  
  
  RESULTS
  Three months after diagnosis, a DAS-28 level of ≥ 3.2 was associated with high direct and indirect costs over the following 4 years. Patients with DAS-28 ≥ 3.2 at 3-month follow-up had more visits to physician, physiotherapist, occupational therapist and nurse, higher drug costs, more days in hospital and more extensive surgery compared with patients with 3-month DAS-28 < 3.2. Number of days lost from work due to sick leave and permanent work disability was also higher in this group. The effect of disease activity on health-related quality of life was highly significant. In regression models, DAS-28 at 3-month follow-up was significantly associated with costs over the following years.
  
  
  CONCLUSIONS
  Three months after diagnosis, DAS-28 is an important prognostic marker regarding health-care utilization and costs. Achieving remission or low disease activity 3 months after diagnosis is likely to decrease morbidity, increase quality of life and save costs for the patient and for society over the following years.
authors.affiliation: Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden. eva.hallert@liu.se
authors.forename: Eva
authors.initials: E
authors.lastname: Hallert
authors.forename: Magnus
authors.initials: M
authors.lastname: Husberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Skogh
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D015331:Cohort Studies; D017281:Cost of Illness; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013548:Sweden; D013997:Time Factors