title: Direct health costs of inflammatory polyarthritis 10 years after disease onset: results from the Norfolk Arthritis Register.
abstract: OBJECTIVE
  To explore the change in direct medical costs associated with inflammatory polyarthritis (IP) 10 to 15 years after its onset.
  
  
  METHODS
  Patients from the Norfolk Arthritis Register who had previously participated in a health economic study in 1999 were traced 10 years later and invited to participate in a further prospective questionnaire-based study. The study was designed to identify direct medical costs and changes in health status over a 6-month period using previously validated questionnaires as the primary source of data.
  
  
  RESULTS
  A representative sample of 101 patients with IP from the 1999 cohort provided complete data over the 6-month period. The mean disease duration was 14 years (SD 2.1, median 13.6, interquartile range 12.6-15.4). The mean direct medical cost per patient over the 6-month period was £1496 for IP (inflated for 2013 prices). This compared with £582 (95% CI £355-£964) inflated to 2013 prices per patient with IP 10 years earlier in their disease. The increased cost was largely associated with the use of biologics in the rheumatoid arthritis subgroup of patients (51% of total costs incurred). Other direct cost components included primary care costs (11%), hospital outpatient (19%), day care (12%), and inpatient stay (4%).
  
  
  CONCLUSIONS
  The direct healthcare costs associated with IP have more than doubled with increasing disease duration, largely as a result of the use of biologics. The results showed a shift in the direct health costs from inpatient to outpatient service use.
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Elena
authors.initials: E
authors.lastname: Nikiphorou
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Davies
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Miranda
authors.initials: M
authors.lastname: Mugford
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cooper
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Alan
authors.initials: A
authors.lastname: Brooksby
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Diane K
authors.initials: DK
authors.lastname: Bunn
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Adam
authors.initials: A
authors.lastname: Young
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Suzanne M M
authors.initials: SM
authors.lastname: Verstappen
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia.
authors.forename: Deborah P M
authors.initials: DP
authors.lastname: Symmons
authors.affiliation: From the Department of Applied Health Research, University College London, London; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, Hatfield; Norwich Medical School, University of East Anglia; Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital, Norwich; Department of Epidemiology and Public Health, University of Leicester, Leicester; Arthritis Research UK Centre for Epidemiology, University of Manchester; National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, UK.E. Nikiphorou, MBBS/BSc, MRCP, MD(Res)PGCME, FHEA, Department of Applied Health Research, University College London, and Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; C. Davies, BSc, MSc, PhD; M. Mugford, BA (Hons), D Phil Health Economics, Norwich Medical School, University of East Anglia; N. Cooper, BSc, MSc, PhD, Department of Epidemiology and Public Health, University of Leicester; A. Brooksby, BSc (Hons), MSc, Clinical Effectiveness and Audit Department, Norfolk and Norwich University Hospital; D.K. Bunn, BSc, MSc, RGN, RM, Norwich Medical School, University of East Anglia; A. Young, BA, MA, MB, BChir (Cantab), FRCP, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; S.M. Verstappen, MSc, PhD, Arthritis Research UK Centre for Epidemiology, University of Manchester; D.P. Symmons, MD, FRCP, Arthritis Research UK Centre for Epidemiology, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit; A.J. MacGregor, FRCP, MD, PhD, Norwich Medical School, University of East Anglia. a.macgregor@uea.ac.uk.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: MacGregor
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D001688:Biological Products / Q000191:economics* / Q000627:therapeutic use; D004739:England; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: DIRECT HEALTH COSTS; HEALTH SERVICE PROVISION; INFLAMMATORY POLYARTHRITIS; RHEUMATOID ARTHRITIS