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Direct and Indirect Costs Attributable to Osteoarthritis in Active Subjects
VÉRONIQUE RABENDA, CHRISTELLE MANETTE, RÉGINE LEMMENS, ANNE-MARIE MARIANI, NICOLE STRUVAY, and JEAN-YVES REGINSTER ABSTRACT. Objective. To estimate the direct and indirect costs of osteoarthritis (OA) in an active population, and to identify factors significantly influencing these expenditures. Methods. A cohort of 3440 subjects employed by the Liège City Council was followed prospectively for 6 months. Subjects were asked to report monthly OA related health resource utilization (contacts with health professionals, medical examinations, drug consumption, etc.) and absence from work. Health related quality of life (HRQOL) was evaluated at baseline using the Medical Outcomes Study Short-form 36 (SF-36). Logistic regression analysis identified factors associated with the probability that the individual incurred costs, and multiple regression identified factors influencing the magnitude of these costs. Results. A total of 1811 subjects filled in at least one questionnaire (response rate 52%). The mean duration of followup was 3.46 months. Self-reported prevalence of OA was 34.1%. The mean total direct costs were €44.5 per OA patient-month. Contacts with health professionals, medical examinations, drugs, and hospital stays accounted for €23.7, €8.7, €6.7, and €4.9, respectively, per OA patient-month. The average number of sick-leave days was 0.8 per OA patient-month. From a payer's perspective, this loss of productivity represented a mean cost of €64.5 per OA patient-month. We also recorded 0.02 mean days off work per active subject-month due to informal care by relatives, yielding a mean cost of €1.8 per active subject-month for the employer. Poorer scores for most of the dimensions of the SF-36 at baseline were significantly associated with greater likelihood of incurring direct and indirect costs and with higher costs among subjects who reported costs. If we consider the overall cohort of active subjects, the burden of OA related to the direct and indirect costs was €15.2 and €23.8, respectively, per active subject-month. Conclusion. Direct and indirect costs attributable to OA are substantial, with productivity related costs being predominant. Poorer HRQOL was a major determinant of these expenditures. (J Rheumatol 2006;33:1152-8) Key Indexing Terms:
WORKPLACE
From the Department of Public Health, Epidemiology and Health Economics, University of Liège; World Health Organization Collaborating Center for Public Health Aspects of Osteoarticular Disorders; and the Department of Population, Liège City Council, Liège, Belgium. Supported by an unrestricted educational grant from Roche and GlaxoSmithKline. V. Rabenda, MSc, Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Osteoarticular Disorders; C. Manette, MSc, Department of Public Health, Epidemiology and Health Economics, University of Liège; R. Lemmens, BSc; A-M. Mariani, LLB; N. Struvay, BSc, Department of Population, Liège City Council; J-Y. Reginster, MD, PhD, Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Osteoarticular Disorders. Address reprint requests to V. Rabenda, Department of Public Health, Epidemiology and Health Economics, CHU, Bât. B23, 4000 Liège, Belgium. E-mail: veronique.rabenda@ulg.ac.be Accepted for publication January 24, 2006.
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