Osteoarthritis: Socioeconomic Problems

Abstract

S W o d r e d p steoarthritis (OA) has considerable socioeconomic importance in Italy. It is the leading cause of working isability (1) and the second leading cause of permanent isablement (2). Furthermore, it will become increasingly mportant because of aging of the Italian population. The costs of OA have not been determined. Having reently become aware of the seriousness and risks of some orms of OA, we studied the costs using methods capable of roviding reliable data. In particular, we no longer use the top-down” method, which calculates the costs of illness COI) on the basis of aggregate data of national expenditure n proportion to the prevalence of the same disease. We are sing the “bottom-up” method, in which cost estimates are ased on the sum of individual items recorded in a represenative sample multiplied by the total number of patients. The rst method favors ease of calculation, but the second enures precise calculations (3). We therefore now can calculate exactly the 2 components f the social costs of OA: direct medical (such as hospitalizaions, diagnosis, and treatment) and nonmedical costs (such s the use of special devices to perform daily activities), and ndirect costs represented by lost resources. Indirect costs are lassified into 2 groups: 1) morbidity costs (mainly producivity losses sustained by the patients, their family, and socity); and 2) mortality costs, which represent the current alue of lost production resulting from the premature death f the patient. For the first time in Italy, we also calculated intangible osts, ie, those represented by the deterioration in the quality f life (QoL) of the patients and their caregivers. These consist f the deterioration in social relations, isolation, distress, and he pain characteristic of chronic diseases. Because they are xtremely difficult to quantify, they often are not taken into ccount by COI analysis (4).