title: Costs in Relation to Disability, Disease Activity, and Health-related Quality of Life in Rheumatoid Arthritis: Observational Data from Southern Sweden.
abstract: To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA).
  
  
  
  Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005-2010. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare (patient care and drugs) and work loss costs (patients < 65 yrs) were studied in separate regression models, comparing standardized β coefficients by nonparametric bootstrapping to assess which measure best reflects costs. Analyses were conducted based on both individual means (linear regression, comparing between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs.
  
  
  
  Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work loss costs were also more closely associated with EQ-5D than DAS28. The results of the linear models for healthcare costs were standardized β = 0.21 (95% CI 0.15-0.27), 0.16 (0.11-0.21), and -0.15 (-0.21 to -0.10) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D). For work loss costs, the results were standardized β = 0.43 (95% CI 0.39-0.48), 0.27 (0.23-0.32), and -0.34 (-0.38 to -0.29) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D and for EQ-5D vs DAS28).
  
  
  
  Overall, HAQ disability is a better marker of RA costs than DAS28 or EQ-5D HRQOL.
authors.affiliation: From the Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; Department of Rheumatology, Skåne University Hospital, Lund; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rheumatology, The Parker Institute, Frederiksberg and Bispebjerg, Denmark.J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; J.K. Eriksson, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; J.Å. Nilsson, Biostatistician, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; T. Olofsson, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; L.E. Kristensen, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and the Department of Rheumatology, The Parker Institute; M. Neovius, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; P. Geborek, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital. johan.81.karlsson@gmail.com.
authors.forename: Johan K
authors.initials: JK
authors.lastname: Wallman
authors.affiliation: From the Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; Department of Rheumatology, Skåne University Hospital, Lund; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rheumatology, The Parker Institute, Frederiksberg and Bispebjerg, Denmark.J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; J.K. Eriksson, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; J.Å. Nilsson, Biostatistician, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; T. Olofsson, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; L.E. Kristensen, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and the Department of Rheumatology, The Parker Institute; M. Neovius, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; P. Geborek, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital.
authors.forename: Jonas K
authors.initials: JK
authors.lastname: Eriksson
authors.affiliation: From the Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; Department of Rheumatology, Skåne University Hospital, Lund; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rheumatology, The Parker Institute, Frederiksberg and Bispebjerg, Denmark.J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; J.K. Eriksson, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; J.Å. Nilsson, Biostatistician, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; T. Olofsson, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; L.E. Kristensen, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and the Department of Rheumatology, The Parker Institute; M. Neovius, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; P. Geborek, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital.
authors.forename: Jan-Åke
authors.initials: JÅ
authors.lastname: Nilsson
authors.affiliation: From the Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; Department of Rheumatology, Skåne University Hospital, Lund; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rheumatology, The Parker Institute, Frederiksberg and Bispebjerg, Denmark.J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; J.K. Eriksson, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; J.Å. Nilsson, Biostatistician, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; T. Olofsson, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; L.E. Kristensen, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and the Department of Rheumatology, The Parker Institute; M. Neovius, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; P. Geborek, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital.
authors.forename: Tor
authors.initials: T
authors.lastname: Olofsson
authors.affiliation: From the Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; Department of Rheumatology, Skåne University Hospital, Lund; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rheumatology, The Parker Institute, Frederiksberg and Bispebjerg, Denmark.J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; J.K. Eriksson, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; J.Å. Nilsson, Biostatistician, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; T. Olofsson, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; L.E. Kristensen, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and the Department of Rheumatology, The Parker Institute; M. Neovius, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; P. Geborek, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital.
authors.forename: Lars-Erik
authors.initials: LE
authors.lastname: Kristensen
authors.affiliation: From the Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; Department of Rheumatology, Skåne University Hospital, Lund; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rheumatology, The Parker Institute, Frederiksberg and Bispebjerg, Denmark.J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; J.K. Eriksson, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; J.Å. Nilsson, Biostatistician, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; T. Olofsson, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; L.E. Kristensen, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and the Department of Rheumatology, The Parker Institute; M. Neovius, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; P. Geborek, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital.
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
authors.affiliation: From the Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; Department of Rheumatology, Skåne University Hospital, Lund; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Rheumatology, The Parker Institute, Frederiksberg and Bispebjerg, Denmark.J.K. Wallman, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; J.K. Eriksson, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; J.Å. Nilsson, Biostatistician, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University; T. Olofsson, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital; L.E. Kristensen, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and the Department of Rheumatology, The Parker Institute; M. Neovius, PhD, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet; P. Geborek, MD, PhD, Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, and Department of Rheumatology, Skåne University Hospital.
authors.forename: Pierre
authors.initials: P
authors.lastname: Geborek
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D004185:Disability Evaluation; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D013548:Sweden; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: COST OF ILLNESS; DISEASE ACTIVITY SCORE; OUTCOMES; RHEUMATOID ARTHRITIS; TUMOR NECROSIS FACTOR INHIBITORS