Rheumatoid arthritis (RA) is a major cause of progressive joint damage and disability, and is associated with decline in quality of life, reduced ability to work and increased health care utilization. The economic consequences of the disease are substantial for the individuals and their families and for the society as a whole. This thesis describes a 5-year follow up of 320 patients with early RA, enrolled between January 1996 and April 1998 in the Swedish multi-centre inception cohort TIRA (early interventions in rheumatoid arthritis). Health status, function and costs were investigated. Predictors of high costs were calculated, and an algorithm was constructed to predict future need for TNF inhibitor treatment in patients not responding to traditional disease-modifying anti-rheumatic drugs (DMARDs). Clinical and laboratory data, measures of functional capacity and self-reported assessments were collected regularly. In addition, patients completed biannual/annual questionnaires concerning all health care utilization and days lost from work due to the disease. Within 3 months, improvements were seen regarding all variables assessing disease activity and functional ability, but 15% of the patients had sustained high or moderate disease activity throughout the study period. The scores of ‘health assessment questionnaire’ (HAQ) were similar for men and women at baseline, but had a less favourable course in women, who also had DMARDs more frequently prescribed.Ambulatory care accounted for 76% of the direct costs during the first year. Women had more ambulatory care visits and higher usage of complementary medicine compared to men…
Contents
INTRODUCTION
Rheumatoid arthritis
Assessments
Disease activity
Function
Economic burden
General
Direct costs
Indirect costs
Intangible costs
Treatment
The Swedish TIRA project
AIMS OF THE STUDY
PATIENTS AND METHODS
Disease and disease activity
Function and general health
Health care questionnaire
Statistical analyses
RESULTS
Course of disease and function (papers I and III)
Costs and predictors of costs (paper II)
Costs over 3 years (paper III)
Early predictors of TNF-targeted therapy (paper IV)
DISCUSSION
Disease and function (papers I and III)
Direct and indirect costs and predictors of high costs
(papers II and III)
Predictors of TNF-targeted therapy (paper IV)
CONCLUSIONS
SUMMARY IN SWEDISH/SAMMANFATTNING PÅ SVENSKA
ACKNOWLEDGEMENTS
REFERENCES
Author: Hallert, Eva
Source: Linkoping University
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