title: Societal costs and patients' experience of health inequities before and after diagnosis of psoriatic arthritis: a Danish cohort study.
abstract: OBJECTIVE
  To comprehensively study the comorbidities, healthcare and public transfer (allowance) costs in patients with psoriatic arthritis (PsA) before and after diagnosis.
  
  
  METHODS
  Nationwide cohort study, using data from Danish registries from January 1998 through December 2014. A total of 10 525 patients with PsA and 20 777 matched general population comparator (GPC) subjects were included. Societal costs, employment status and occurrence of comorbidities in patients with PsA both before and after diagnosis were compared with GPC subjects.
  
  
  RESULTS
  At baseline, patients with PsA had significantly more comorbidities, including cardiovascular disease (OR 1.70 95% CI 1.55 to 1.86), respiratory diseases (OR 1.73 95% CI 1.54 to 1.96) and infectious diseases (OR 2.03 95% CI 1.69 to 2.42) compared with GPC subjects. At all time points, patients with PsA had higher total healthcare and public transfer costs; they also had lower income (p<0.001) and incurred a net average increased societal cost of €10 641 per patient-year compared with GPC subjects following diagnosis. The relative risk (RR) for being on disability pension 5 years prior to PsA diagnosis was 1.36 (95% CI 1.24 to 1.49) compared with GPC subjects. The RR increased to 1.60 (95% CI 1.49 to 1.72) at the time of diagnosis and was 2.69 (95% CI 2.40 to 3.02) 10 years after diagnosis, where 21.8% of the patients with PsA received disability pension.
  
  
  CONCLUSIONS
  Our findings are suggestive of health inequity for patients with PsA and call for individual preventive measures and societal action.
authors.affiliation: The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark.
authors.forename: Lars Erik
authors.initials: LE
authors.lastname: Kristensen
authors.affiliation: The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark.
authors.forename: Tanja S
authors.initials: TS
authors.lastname: Jørgensen
authors.affiliation: The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark.
authors.forename: Robin
authors.initials: R
authors.lastname: Christensen
authors.affiliation: The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Gudbergsen
authors.affiliation: The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark.|Gentofte Hospital, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Hellerup, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Dreyer
authors.affiliation: The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark.
authors.forename: Christine
authors.initials: C
authors.lastname: Ballegaard
authors.affiliation: Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lennart T H
authors.initials: LTH
authors.lastname: Jacobsson
authors.affiliation: Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Strand
authors.affiliation: Swedish Medical Center and University of Washington, Seattle, Washington, USA.
authors.forename: Philip J
authors.identifier: http://orcid.org/0000-0002-6620-0457
authors.initials: PJ
authors.lastname: Mease
authors.affiliation: Danish Institute for Local and Regional Government Research, Copenhagen, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Kjellberg
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D003141:Communicable Diseases / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D003718:Denmark; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D010415:Pensions; D012042:Registries; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D018582:Sick Leave
keywords: Economic Evaluations; Epidemiology; Patient perspective; Psoriatic Arthritis