title: Finding Rheumatoid Arthritis Impact on Life (FRAIL Study): economic burden.
abstract: BACKGROUND
  The economic impact of rheumatoid arthritis (RA) is related with the costs supported by the society. It is of the utmost importance to estimate the costs of RA in Portugal in order to access its true social impact and improve the clinical management of this disease.
  
  
  OBJECTIVE
  To determine the yearly direct and indirect costs of RA supported by the society in Portugal.
  
  
  METHODS
  Observational, cross-sectional study with collection of retrospective data, involving patients with RA, diagnosed accordingly to 1987 American College of Rheumatology (ACR) criteria, independently of disease stage, with attendance to a specialist visit between October and December 2009 in a Rheumatology Clinic in Portugal. Data were obtained through the fulfillment of medical and patient questionnaires. Data being covered included socio-demographic and clinical characteristics and health resources. The societal perspective was considered including direct and indirect costs. Unitary costs were obtained from official national sources.
  
  
  RESULTS
  The FRAIL study included 353 patients, 84% females, with an average age of 59 (range: 23-85 years). In the previous year: 97.2% of patients had a Rheumatology appointment (average: 4) and 35.6% a GP appointments (average: 6); 8.2% were hospitalized at least once, 9.3% had an urgency admission and 41.4% went to the day hospital. Most of the patients (96.0%) were on DMARD; 94.3% performed routine exams; 35.7% had rehabilitation treatments; 21.4% had alternative medicine treatments; 5.7% needed house adaptations; 9.3% needed prosthesis; 5.1% needed permanent home support, 2.9% partial; 31% of the patients referred sick leave because of RA. We estimate that the annual mean cost of treating one RA patient in Portugal is about 3.415 €, of which 77.3%, 9.6% and 11.4%, corresponds to direct medical, direct non-medical and indirect cost, respectively. Total cost of the disease increase with disease activity. RA in remission has an average cost of 2.205 €/patient/year versus 5.634 € in high activity RA.
  
  
  CONCLUSIONS
  Results of the FRAIL study allow a better understanding of the real economic impact of RA for society, which increased very significantly in the last 10 years. If we consider 35,000 patients with RA in Portugal, the annual cost would be 119,525,000 € per year.
authors.affiliation: Instituto Português de Reumatologia, Lisboa, Portugal. luis.miranda@ipr.pt
authors.forename: Luis Cunha
authors.initials: LC
authors.lastname: Miranda
authors.forename: Helena
authors.initials: H
authors.lastname: Santos
authors.forename: Júlia
authors.initials: J
authors.lastname: Ferreira
authors.forename: Paulo
authors.initials: P
authors.lastname: Coelho
authors.forename: Catarina
authors.initials: C
authors.lastname: Silva
authors.forename: José
authors.initials: J
authors.lastname: Saraiva-Ribeiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000191:economics*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal; D012189:Retrospective Studies; D055815:Young Adult