Functional Status and Radiographic Joint Damage Are Associated with Health Economic Outcomes in Patients with Rheumatoid Arthritis

ARTHUR KAVANAUGH, CHENGLONG HAN, and MOHAN BALA

ABSTRACT.

Objective. This analysis examines the relationship between the functional and radiographic measures of disease activity and the employment status in patients with rheumatoid arthritis (RA). We also assessed the influence of improvement in physical function on employability, healthcare costs, and quality of life, utilizing data collected in the ATTRACT trial.

Methods. During the ATTRACT trial, the Health Assessment Questionnaire (HAQ) disability index, radiographic damage measured by the van der Heijde modified Sharp (vdH-Sharp) score, employment status, healthcare resource utilization, and quality of life measured by Medical Outcomes Survey Short Form-36 were assessed at baseline and again periodically through Week 54. Clinically important improvement was defined as an improvement in the HAQ of ³ 0.25 from baseline to Week 54.

Results. There was a significant association at baseline between functional status and the percentages of patients employed. Increased radiographic joint damage was associated with lower fulltime employment rate, with patients in the 2 highest quartiles (vdH-Sharp score > 51.5) of radiographic damage having lower rates of fulltime employment than those with less damage. During the ATTRACT trial, patients who achieved a clinically important improvement in HAQ scores had a significant improvement in their employability (21% vs 3%; p < 0.001), in their time lost from work (7 vs 30 days; p = 0.012), in their total/direct medical costs (US$7093/$6791 vs $11,712/$10,039; p < 0.001), and in their quality of life (p < 0.001) compared with those who did not demonstrate this improvement.

Conclusion. Functional disability and radiographic joint damage are correlated with employment in patients with RA. Clinically important improvement in HAQ scores is associated with substantial health economic and quality of life benefits for patients with RA. (J Rheumatol 2004;31:849-55)

Key Indexing Terms:

HEALTH ECONOMICS
EMPLOYABILITY
DISABILITY
RHEUMATOID ARTHRITIS
HEALTH ASSESSMENT QUESTIONNAIRE
RADIOGRAPHIC DAMAGE

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From the Center for Innovative Therapy, Division of Rheumatology, Allergy and Immunology, University of California at San Diego, La Jolla, California, USA.

Centocor, Inc., Malvern, PA, USA, conducted the ATTRACT trial.

A. Kavanaugh, MD, Professor of Medicine, Director, the Center for Innovative Therapy; C. Han, PhD, Senior Manager, Outcomes Research; M. Bala, PhD, Director, Outcomes Research, Centocor, Malvern, PA, USA.

Address reprint requests to Dr. A. Kavanaugh, Center for Innovative Therapy, UCSD, Division of Rheumatology, Allergy and Immunology, 9500 Gilman Drive, La Jolla, CA 92093-0943. E-mail:akavanaugh@ucsd.edu

Submitted March 7, 2003; revision accepted October 2, 2003.

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