title: Healthcare costs and productivity losses directly attributable to ankylosing spondylitis.
abstract: OBJECTIVE
  To describe the healthcare resource use and productivity losses associated with patients with ankylosing spondylitis (AS) and explore the relationship between disease severity and total costs.
  
  
  METHODS
  A cross-sectional postal survey was conducted on a sample of 1,000 patients with AS randomly selected from registries at 10 secondary care rheumatology centres in the UK. Information on demographic characteristics, disease and functional activity, healthcare use and work status (presenteeism and absenteeism) during the previous three months was collected. The relationship between disease severity and total costs was explored using a two-part regression model, controlling for age, gender and disease duration and validated on respondents (n=470) of the second round of the survey.
  
  
  RESULTS
  Respondents at baseline (n=612) covered the full spectrum of AS, had a mean BASDAI of 4.6 and 55.3% of individuals scored at least 4 on the BASDAI scale. The mean (median) three month total cost was £2,802 (£1,160). Both physical function and disease activity were significant predictors of total costs. Mean (median) three month total costs for patients with BASDAI <4, 4-6 and >6 were £1,331 (£502), £2,790 (£1,281) and £4,840 (£5,017) respectively. Direct National Health Service funded healthcare costs contributed to just 15% of total costs while unemployment, absenteeism from work and reduced productivity at work accounted for 63.2%, 1.4% and 19.0% of total costs, respectively.
  
  
  CONCLUSIONS
  This study shows that direct healthcare costs alone do not describe the total costs associated with AS and that productivity losses associated with AS are considerable.
authors.affiliation: University of Sheffield, School of Health and Related Research, Health Economics and Decision Science, Sheffield, UK. r.rafia@sheffield.ac.uk
authors.forename: Rachid
authors.initials: R
authors.lastname: Rafia
authors.forename: Roberta
authors.initials: R
authors.lastname: Ara
authors.forename: Jon
authors.initials: J
authors.lastname: Packham
authors.forename: Kristie L
authors.initials: KL
authors.lastname: Haywood
authors.forename: Emma
authors.initials: E
authors.lastname: Healey
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004526:Efficiency; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D012042:Registries; D012044:Regression Analysis; D012720:Severity of Illness Index; D018582:Sick Leave / Q000191:economics*; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D013222:State Medicine / Q000191:economics*; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult