title: The Cost of Ankylosing Spondylitis in the UK Using Linked Routine and Patient-Reported Survey Data.
abstract: BACKGROUND
  Ankylosing spondylitis (AS) is a chronic inflammatory arthritis which typically begins in early adulthood and impacts on healthcare resource utilisation and the ability to work. Previous studies examining the cost of AS have relied on patient-reported questionnaires based on recall. This study uses a combination of patient-reported and linked-routine data to examine the cost of AS in Wales, UK.
  
  
  METHODS
  Participants in an existing AS cohort study (n = 570) completed questionnaires regarding work status, out-of-pocket expenses, visits to health professionals and disease severity. Participants gave consent for their data to be linked to routine primary and secondary care clinical datasets. Health resource costs were calculated using a bottom-up micro-costing approach. Human capital costs methods were used to estimate work productivity loss costs, particularly relating to work and early retirement. Regression analyses were used to account for age, gender, disease activity.
  
  
  RESULTS
  The total cost of AS in the UK is estimated at £19016 per patient per year, calculated to include GP attendance, administration costs and hospital costs derived from routine data records, plus patient-reported non-NHS costs, out-of-pocket AS-related expenses, early retirement, absenteeism, presenteeism and unpaid assistance costs. The majority of the cost (>80%) was as a result of work-related costs.
  
  
  CONCLUSIONS
  The major cost of AS is as a result of loss of working hours, early retirement and unpaid carer's time. Therefore, much of AS costs are hidden and not easy to quantify. Functional impairment is the main factor associated with increased cost of AS. Interventions which keep people in work to retirement age and reduce functional impairment would have the greatest impact on reducing costs of AS. The combination of patient-reported and linked routine data significantly enhanced the health economic analysis and this methodology that can be applied to other chronic conditions.
authors.affiliation: College of Medicine, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Cooksey
authors.affiliation: Keele Management School, Keele University, Keele, Newcastle, England, United Kingdom.
authors.forename: Muhammad J
authors.initials: MJ
authors.lastname: Husain
authors.affiliation: College of Medicine, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Sinead
authors.initials: S
authors.lastname: Brophy
authors.affiliation: College of Medicine, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Davies
authors.affiliation: College of Medicine, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Rahman
authors.affiliation: College of Medicine, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Atkinson
authors.affiliation: College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Ceri J
authors.initials: CJ
authors.lastname: Phillips
authors.affiliation: Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: Stefan
authors.initials: S
authors.lastname: Siebert
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012179:Retirement / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000191:economics* / Q000453:epidemiology / Q000473:pathology; D011795:Surveys and Questionnaires; D014852:Wales / Q000453:epidemiology