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The Effect of Health Related Quality of Life on Reported Use of Health Care Resources in Patients with Osteoarthritis and Rheumatoid Arthritis: A Longitudinal Analysis
OLIVIER ETHGEN, KRISTIJAN H. KAHLER, SHELDON X. KONG, JEAN-YVES REGINSTER, and FREDERICK WOLFE
ABSTRACT.
Methods. A total of 642 patients with rheumatoid arthritis (RA) and 395 patients with osteoarthritis (OA) completed at least 2 and as many as 6 consecutive surveys at 6 mo intervals. Information collected included demographics, HRQL questionnaires [Medical Outcome Study Short Form 36 (SF-36), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and the Stanford Health Assessment Questionnaire (HAQ)], and HCRU over the previous 6 months. Longitudinal data analysis was performed to assess the effect of HRQL on future HCRU. Results. Statistically significant associations between HCRU and HRQL variables were noted. Higher rates of HCRU were found in those in the worst quarter compared with those in the best quarter of HRQL. With the HAQ, OA and RA patients in the worst quarter reported a 199% (p < 0.05) and 48% (p < 0.05) increase in rheumatologist visits, respectively. With the WOMAC Function, increases were as high as 196% (p < 0.05) in rheumatologist visits for patients with OA. Patients with RA with a high level of HRQL as measured by the SF-36 (physical component score) reported a decrease of 31% (p < 0.01) in general practitioner visits and a decrease of 52% (p < 0.01) in hospitalization (mental component score). Conclusion. These findings suggest that HRQL may be used to predict future health care consumption. Such an approach may lead to a more efficient allocation of resources by providing useful information to health care providers and health care decision makers. (J Rheumatol 2002;29:1147-55) Key Indexing Terms:
HEALTH CARE RESOURCE UTILIZATION
From the Department of Public Health and Epidemiology, University of Liege, Liege Belgium; Health Economics and Outcomes Research, Novartis Pharmaceuticals, East Hanover, New Jersey; Outcomes Research, Merck & Co., Inc., Whitehouse Station, New Jersey; University of Liege; WHO Collaborating Center for Public Health Aspects of Osteoarticular Diseases, University of Liege; and the National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA. Supported in part by Merck & Company. O. Ethgen, MSc, Department of Public Health and Epidemiology, and WHO Collaborating Center for Public Health Aspects of Osteoarticular Diseases, University of Liege; K.H. Kahler, RPh, MSc, Health Economics and Outcomes Research, Novartis Pharmaceuticals (formerly Outcomes Research Department, Merck & Co., Inc.); S.X. Kong, PhD, Outcomes Research, Merck & Co., Inc.; J-Y. Reginster, MD, PhD, Department of Public Health and Epidemiology, Bone and Cartilage Research Unit, WHO Collaborating Center for Public Health Aspects of Osteoarticular Diseases, University of Liege; F. Wolfe, MD, National Data Bank for Rheumatic Diseases. Address reprint requests to Dr. F. Wolfe, National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation, 1035 North Emporia, Suite 230, Wichita, KS 67214, USA. E-mail: fwolfe@arthritis-research.org Submitted July 10, 2000; revision accepted December 12, 2001. |