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A review of work-participation, cost-of-illness and cost-effectiveness studies in ankylosing spondylitis

Nature Clinical Practice Rheumatology volume 2, pages 546–553 (2006)Cite this article

Abstract

Ankylosing spondylitis (AS) can have important socioeconomic consequences for individual patients and for society, as symptoms usually appear in the third decade of life. When compared with those of the general population, employment rates for AS patients are significantly decreased in men, but not in women; however, both sexes experience increased AS-related (partial) work disability. In addition, changes in type of work, working hours, and the need for help might be required. AS-related sick leave in patients in paid work varies between 6.5 and 18 days per patient per year. Between 15% and 20% of AS patients require help from relatives or friends to complete unpaid tasks. The majority of the direct health-care costs related to AS are incurred by hospitalizations, physiotherapy, informal care, and drugs. High disease activity and poor physical function are the most important factors associated with the total costs of AS. Cost-effectiveness analyses for different AS therapies have shown variable results. The use of different methodologic approaches to assess the cost-effectiveness ratios makes the findings of such analyses difficult to compare with each other. This article examines the effect of AS on work participation, costs of illness and reviews cost-effectiveness analyses of AS treatments.

Key Points

  • Work participation in patients with ankylosing spondylitis varies among countries

  • In Europe, employment rates for ankylosing spondylitis patients are significantly decreased in men, but not in women when compared with those of the general population

  • Work disability is increased in both sexes when compared with the general population

  • Ankylosing spondylitis patients with paid jobs take more days of sick leave than members of the general population

  • Direct health-care costs related to ankylosing spondylitis are incurred by hospitalizations, physiotherapy, informal care, and drugs

  • Higher disease activity and worse physical function are associated with higher costs of illness

  • Cost-effectiveness studies differ methodologically

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Figure 1: The Framework of the International Classification of Functioning Disability and Health (ICF) shows that activities and participation have a central position in health outcome, and are influenced by a complex interaction with body structures, body functions and environmental as well as personal factors.

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References

  1. van der Linden SM et al. (1984) The risk of developing ankylosing spondylitis in HLA-B27 positive individuals. A comparison of relatives of spondylitis patients with the general population. Arthritis Rheum 27: 241–249

    Article  CAS  Google Scholar 

  2. Braun J et al. (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41: 58–67

    Article  CAS  Google Scholar 

  3. Akkoc N and Khan MA (2005) Overestimation of the prevalence of ankylosing spondylitis in the Berlin study: comment on the article by Braun et al. Arthritis Rheum 52: 4048–4049

    Article  Google Scholar 

  4. Stucki G et al. (2002) Application of the International Classification of Functioning, Disability and Health (ICF) in clinical practice. Disabil Rehabil 24: 281–282

    Article  CAS  Google Scholar 

  5. World Health Organisation (2001) International Classification of Functioning, Disability and Health. Geneva: WHO

  6. Braun J et al. (2002) Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 359: 1187–1193

    Article  CAS  Google Scholar 

  7. Brandt J et al. (2003) Six-month results of a double-blind, placebo-controlled trial of etanercept treatment in patients with active ankylosing spondylitis. Arthritis Rheum 48: 1667–1675

    Article  CAS  Google Scholar 

  8. Davis JC Jr et al. (2003) Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthritis Rheum 48: 3230–3236

    Article  CAS  Google Scholar 

  9. Gorman JD et al. (2002) Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor alpha. NEJM 346: 1349–1356

    Article  CAS  Google Scholar 

  10. Calin A et al. (2004) Outcomes of a multicentre randomised clinical trial of etanercept to treat ankylosing spondylitis. Ann Rheum Dis 63: 1594–1600

    Article  CAS  Google Scholar 

  11. van der Heijde D et al. (2005) Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum 52: 582–591

    Article  CAS  Google Scholar 

  12. Boonen A et al. (2001) Work status and its determinants among patients with ankylosing spondylitis. A systematic literature review. J Rheumatol 28: 1056–1062

    CAS  PubMed  Google Scholar 

  13. Gran JT and Husby G (1984) Ankylosing spondylitis: a comparative study of patients in an epidemiological survey, and those admitted to a department of rheumatology. J Rheumatol 11: 788–793

    CAS  PubMed  Google Scholar 

  14. Lehtinen K (1983) 76 patients with ankylosing spondylitis seen after 30 years of disease. Scand J Rheumatol 12: 5–11

    Article  CAS  Google Scholar 

  15. Guillemin F et al. (1990) Long-term disability and prolonged sick leaves as outcome measurements in ankylosing spondylitis. Possible predictive factors. Arthritis Rheum 33: 1001–1006

    Article  CAS  Google Scholar 

  16. Boonen A et al. (2001) Employment, work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis 60: 353–358

    Article  CAS  Google Scholar 

  17. Boonen A et al. (2001) Withdrawal from labour force due to work disability in patients with ankylosing spondylitis. Ann Rheum Dis 60: 1033–1039

    Article  CAS  Google Scholar 

  18. Boonen A et al. (2002) Work status and productivity costs due to ankylosing spondylitis: comparison of three European countries. Ann Rheum Dis 61: 429–437

    Article  CAS  Google Scholar 

  19. Barlow JH et al. (2001) Work disability among patients with ankylosing spondylitis. Arthritis Care Res 45: 424–429

    Article  CAS  Google Scholar 

  20. Mau W et al. (2005) Employment across chronic inflammatory rheumatic diseases and comparison with the general population. J Rheumatol 32: 721–728

    PubMed  Google Scholar 

  21. Zink A et al. (2000) Disability and handicap in rheumatoid arthritis and ankylosing spondylitis. Results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol 27: 613–622

    CAS  PubMed  Google Scholar 

  22. Ward M and Kuzis S (2001) Risk Factors for Work disability in Patients with Ankylosing Spndylitis. J Rheumatol 28: 315–321

    CAS  PubMed  Google Scholar 

  23. Wordsworth BP and Mowat AG (1986) A review of 100 patients with ankylosing spondylitis with particular reference to socio-economic effects. Br J Rheumatol 25: 175–180

    Article  CAS  Google Scholar 

  24. Kobelt G et al. (2004) The burden of ankylosing spondylitis and the cost-effectiveness of treatment with infliximab (Remicade(R)). Rheumatology (Oxford) 43: 1158–1166

    Article  CAS  Google Scholar 

  25. Kobelt G et al. (2006) Costs and quality of life of patients with ankylosing spondylitis in Canada. J Rheumatol 33: 289–295

    PubMed  Google Scholar 

  26. Boonen A et al. (2003) Direct costs of ankylosing spondylitis and its determinants: an analysis among three European countries. Ann Rheum Dis 62: 732–740

    Article  CAS  Google Scholar 

  27. Boonen A et al. (2005) Large differences in cost of illness and wellbeing between patients with fibromyalgia, chronic low back pain, or ankylosing spondylitis. Ann Rheum Dis 64: 396–402

    Article  CAS  Google Scholar 

  28. Ward MM (2002) Functional disability predicts total costs in patients with ankylosing spondylitis. Arthr Rheum 46: 223–231

    Article  Google Scholar 

  29. Boonen A and van der Heijde D (2005) Review of the cost of illness of ankylosing spondylitis and methodological notes. Expert Rev Pharmacoeconomics Outcomes Res 5: 163–181

    Article  Google Scholar 

  30. Van Tubergen A et al. (2002) Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum 47: 459–467

    Article  Google Scholar 

  31. Kobelt G et al. (2006) The cost-effectiveness of infliximab (Remicade®) in the treatment of ankylosing spondylitis in Canada. J Rheumatol 33: 732–740

    CAS  PubMed  Google Scholar 

  32. Boonen A et al. (2006) Markov model into the cost-utility of etanercept and infliximab in patients with active ankylosing spondylitis. Annals Rheum Dis 65: 201–208

    Article  CAS  Google Scholar 

  33. Calin A et al. (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21: 2281–2285

    CAS  PubMed  Google Scholar 

  34. Garrett S et al. (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21: 2286–2291

    CAS  PubMed  Google Scholar 

  35. EuroQol Group (1990) EuroQol: a new facility for the measurement of health-related quality of life. Health Policy 16: 199–208

  36. van Echteld I et al. Identification of the most common problems by patients with ankylosing spondylitis using the International Classification of Functioning, Disability and Health. J Rheumatol, in press

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Authors and Affiliations

  1. A Boonen is a Rheumatologist at the Department of Internal Medicine, Division of Rheumatology and Caphri Research Institute, University Hospital Maastricht, The Netherlands

    Annelies Boonen

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  1. Annelies Boonen
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Boonen, A. A review of work-participation, cost-of-illness and cost-effectiveness studies in ankylosing spondylitis. Nat Rev Rheumatol 2, 546–553 (2006). https://doi.org/10.1038/ncprheum0297

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