title: Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey.
abstract: OBJECTIVE
  To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients.
  
  
  METHODS
  In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs.
  
  
  RESULTS
  The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9.4±7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire-Disability Index (5.08±2.34 and 1.08±0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7±9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was € 4,954 (median, € 1,805), whereas the mean annual indirect cost was € 2,802 (median, € 608). Pharmacy costs accounted for the highest expenditure (mean, € 2,777; median, € 791), followed by the RA-related consultations and expenses (mean, € 1,600; median, € 696).
  
  
  CONCLUSIONS
  RA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpaşa Faculty of Medicine, Turkey. vhamuryudan@yahoo.com.
authors.forename: Vedat
authors.initials: V
authors.lastname: Hamuryudan
authors.affiliation: Department of Rheumatology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey.
authors.forename: Haner
authors.initials: H
authors.lastname: Direskeneli
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ihsan
authors.initials: I
authors.lastname: Ertenli
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Istanbul University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Inanc
authors.affiliation: Department of Internal Medicine, Hitit University Faculty of Medicine, Çorum; and Rheumatology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Karaaslan
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey.
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Oksel
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Çukurova University Faculty of Medicine, Balcalı Hospital, Adana, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Ozbek
authors.affiliation: Department of Rheumatology, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Pay
authors.affiliation: Department of Internal Medicine, Akdeniz University Faculty of Medicine, Antalya, Turkey.
authors.forename: Ender
authors.initials: E
authors.lastname: Terzioglu
authors.affiliation: Medical Department, Pfizer Pharmaceuticals, Istanbul, Turkey.
authors.forename: Dilara
authors.initials: D
authors.lastname: Balkan Tezer
authors.affiliation: Department of Health Economics, Pfizer Pharmaceuticals, Istanbul, Turkey.
authors.forename: Basak
authors.initials: B
authors.lastname: Hacibedel
authors.affiliation: Division of Rheumatology and Immunology, Department of Internal Medicine, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey.
authors.forename: Nurullah
authors.initials: N
authors.lastname: Akkoc
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D001688:Biological Products / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014421:Turkey
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products