Abstract
BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory arthritis which typically begins in early adulthood and impacts on healthcare resource utilisation and the ability to work. Previous studies examining the cost of AS have relied on patient-reported questionnaires based on recall. This study uses a combination of patient-reported and linked-routine data to examine the cost of AS in Wales, UK.MethodsParticipants in an existing AS cohort study (n = 570) completed questionnaires regarding work status, out-of-pocket expenses, visits to health professionals and disease severity. Participants gave consent for their data to be linked to routine primary and secondary care clinical datasets. Health resource costs were calculated using a bottom-up micro-costing approach. Human capital costs methods were used to estimate work productivity loss costs, particularly relating to work and early retirement. Regression analyses were used to account for age, gender, disease activity.ResultsThe total cost of AS in the UK is estimated at £19016 per patient per year, calculated to include GP attendance, administration costs and hospital costs derived from routine data records, plus patient-reported non-NHS costs, out-of-pocket AS-related expenses, early retirement, absenteeism, presenteeism and unpaid assistance costs. The majority of the cost (>80%) was as a result of work-related costs.ConclusionThe major cost of AS is as a result of loss of working hours, early retirement and unpaid carer’s time. Therefore, much of AS costs are hidden and not easy to quantify. Functional impairment is the main factor associated with increased cost of AS. Interventions which keep people in work to retirement age and reduce functional impairment would have the greatest impact on reducing costs of AS. The combination of patient-reported and linked routine data significantly enhanced the health economic analysis and this methodology that can be applied to other chronic conditions.
Highlights
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis which typically begins in early adulthood and impacts on healthcare resource utilisation and the ability to work
The total cost of Ankylosing Spondylitis (AS) in the UK is estimated at £19016 per patient per year, calculated to include General Practice (GP) attendance, administration costs and hospital costs derived from routine data records, plus patient-reported non-National Health Service (NHS) costs, out-of-pocket AS-related expenses, early retirement, absenteeism, presenteeism and unpaid assistance costs
Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis characterised by spinal involvement, with pain, stiffness and reduced range of movement
Summary
Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis characterised by spinal involvement, with pain, stiffness and reduced range of movement. Costs ranged between £406 and £1073 using the frictional cost method (employers’ perspective) and £3080–£7561 using the human capital approach (patients’ perspective). These large differences between countries makes it difficult to generalise work-related costs beyond the country of origin and suggests the majority of costs may be difficult to quantify. A study in the United Kingdom explored healthcare and productivity losses using patient-reported outcomes and the human capital approach and found that on average, AS total costs over a period of three months were £2802 (or £11208/person/year)(1). Ankylosing spondylitis (AS) is a chronic inflammatory arthritis which typically begins in early adulthood and impacts on healthcare resource utilisation and the ability to work. This study uses a combination of patient-reported and linked-routine data to examine the cost of AS in Wales, UK.
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