title: Counting Costs under Severe Financial Constraints: A Cost-of-Illness Analysis of Spondyloarthropathies in a Tertiary Hospital in Greece.
abstract: OBJECTIVE
  To investigate the total annual direct cost of patients with spondyloarthritis (SpA) in Greece.
  
  
  METHODS
  Retrospective study with 156 patients diagnosed and followed up in the rheumatology clinic of the University Hospital of Ioannina. Sixty-four had ankylosing spondylitis (AS) and 92 had psoriatic arthritis (PsA). Health resource use for each patient was elicited through a retrospective chart review that documented the use of monitoring visits, medications, laboratory/diagnostic tests, and inpatient stays for the previous year from the date that the review took place. Costs were calculated from a third-party payer perspective and are reported in 2014 euros.
  
  
  RESULTS
  The mean ± SD annual direct cost for the patients with SpA reached €8680 ± 6627. For the patients with PsA and AS, the cost was estimated to be €8097 ± 6802 and €9531 ± 6322, respectively. The major cost was medication, which represented 88.9%, 88.2%, and 89.3% of the mean total direct cost for SpA, AS, and PsA, respectively. The annual amount of the scheduled tests for all patients corresponded to 7.5%, and for those performed on an emergency basis, 1.1%. Further, the cost for scheduled and emergency hospitalization, as well as the cost of scheduled visits to an outpatient clinic, corresponded to 2.5% of the mean total annual direct cost for the patients with SpA.
  
  
  CONCLUSIONS
  SpA carries substantial financial cost, especially in the era of new treatment options. Adequate access and treatment for patients with SpA remains a necessity, even in times of fiscal constraint. Thus, the recommendations of the international scientific organizations should be considered when administering high-cost drugs such as biological treatments.
authors.affiliation: From the Department of Rheumatology, General Hospital "G. Hatzikosta"; Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina; Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace, Alexandroupolis; Department of Health Economics, National School of Public Health, Athens, Greece.N. Tsifetaki, MD, Consultant Rheumatologist, Department of Rheumatology, General Hospital "G. Hatzikosta"; M.P. Migkos, MD, Fellow in Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; C. Papagoras, MD, PhD, Rheumatologist, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, and Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace; P.V. Voulgari, MD, Associate Professor of Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; K. Athanasakis, PhD, Research Fellow, Department of Health Economics, National School of Public Health; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina.
authors.forename: Niki
authors.initials: N
authors.lastname: Tsifetaki
authors.affiliation: From the Department of Rheumatology, General Hospital "G. Hatzikosta"; Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina; Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace, Alexandroupolis; Department of Health Economics, National School of Public Health, Athens, Greece.N. Tsifetaki, MD, Consultant Rheumatologist, Department of Rheumatology, General Hospital "G. Hatzikosta"; M.P. Migkos, MD, Fellow in Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; C. Papagoras, MD, PhD, Rheumatologist, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, and Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace; P.V. Voulgari, MD, Associate Professor of Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; K. Athanasakis, PhD, Research Fellow, Department of Health Economics, National School of Public Health; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina.
authors.forename: Michail P
authors.initials: MP
authors.lastname: Migkos
authors.affiliation: From the Department of Rheumatology, General Hospital "G. Hatzikosta"; Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina; Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace, Alexandroupolis; Department of Health Economics, National School of Public Health, Athens, Greece.N. Tsifetaki, MD, Consultant Rheumatologist, Department of Rheumatology, General Hospital "G. Hatzikosta"; M.P. Migkos, MD, Fellow in Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; C. Papagoras, MD, PhD, Rheumatologist, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, and Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace; P.V. Voulgari, MD, Associate Professor of Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; K. Athanasakis, PhD, Research Fellow, Department of Health Economics, National School of Public Health; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Papagoras
authors.affiliation: From the Department of Rheumatology, General Hospital "G. Hatzikosta"; Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina; Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace, Alexandroupolis; Department of Health Economics, National School of Public Health, Athens, Greece.N. Tsifetaki, MD, Consultant Rheumatologist, Department of Rheumatology, General Hospital "G. Hatzikosta"; M.P. Migkos, MD, Fellow in Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; C. Papagoras, MD, PhD, Rheumatologist, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, and Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace; P.V. Voulgari, MD, Associate Professor of Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; K. Athanasakis, PhD, Research Fellow, Department of Health Economics, National School of Public Health; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina.
authors.forename: Paraskevi V
authors.initials: PV
authors.lastname: Voulgari
authors.affiliation: From the Department of Rheumatology, General Hospital "G. Hatzikosta"; Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina; Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace, Alexandroupolis; Department of Health Economics, National School of Public Health, Athens, Greece.N. Tsifetaki, MD, Consultant Rheumatologist, Department of Rheumatology, General Hospital "G. Hatzikosta"; M.P. Migkos, MD, Fellow in Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; C. Papagoras, MD, PhD, Rheumatologist, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, and Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace; P.V. Voulgari, MD, Associate Professor of Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; K. Athanasakis, PhD, Research Fellow, Department of Health Economics, National School of Public Health; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina.
authors.forename: Kostas
authors.initials: K
authors.lastname: Athanasakis
authors.affiliation: From the Department of Rheumatology, General Hospital "G. Hatzikosta"; Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina; Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace, Alexandroupolis; Department of Health Economics, National School of Public Health, Athens, Greece.N. Tsifetaki, MD, Consultant Rheumatologist, Department of Rheumatology, General Hospital "G. Hatzikosta"; M.P. Migkos, MD, Fellow in Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; C. Papagoras, MD, PhD, Rheumatologist, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, and Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace; P.V. Voulgari, MD, Associate Professor of Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; K. Athanasakis, PhD, Research Fellow, Department of Health Economics, National School of Public Health; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina. adrosos@cc.uoi.gr.
authors.forename: Alexandros A
authors.initials: AA
authors.lastname: Drosos
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000191:economics*; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006115:Greece; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D025242:Spondylarthropathies / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D062606:Tertiary Care Centers
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents
keywords: ANKYLOSING SPONDYLITIS; ANNUAL COST; DIRECT COST; PSORIATIC ARTHRITIS; SPONDYLOARTHROPATHIES