Background/Purpose: Ankylosing Spondylitis (AS) is characterized by relatively young onset age, easily causing spinal deformity and stiffness, and seriously influencing the health related Quality of Life (QoL) and engaging heavy economical burden for the patients, their families and even the whole society. There were adequate clinical studies about the Patient-reported Outcomes (PROs), which include Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) et al. This study was designed to assess the clinical value of various PROs in a prospective cohort study of AS patients, and to evaluate the medicine cost and other treatment-related cost of patients with AS in Chinese population, and to explore the global economical burden and the factors that may affect the cost.

Methods: 517 AS patients were collected from the Department of Rheumatology, Chinese PLA General Hospital. Data were obtained from Smart Management System (SMSP) for Spondyloarthritis collected online. The Quality of Life (QoL) were assessed by SF-36 questionnaire and compared with the general Chinese population. The correlation between QoL and clinical measures of AS, including BASDAI, BASFI et al, were analysed.Meanwhile, a retrospective study of 283 AS patients and multivariate logistic regression analysis were performed to explore the global economical burden and influence factors.

Results: BASDAI and BASFI were significantly correlated with SF-36 scores(r＞0.3, P＜0.01). Logistic multiple regression analysis showed that BASDAI, BASFI, BASMI and education had close correlation with the baseline global QoL, physical and mental health. BASDAI variation showed the most important influence on the change of global QoL, physical health and mental health (OR=0.235, 0.209, 0.125; P<0.01). The total average medicine cost in the past year was $2654.27 per patient，of which non-steroid anti-inflammatory drugs represented 4.2% percentages, conventional disease modifying anti-rheumatic drugs represented 11.7%, biological disease modifying anti-rheumatic drugs represented 81.9%, herbal drugs represented 2.2%. The mean value of other cost correlated with the treatment of AS were laboratory examination ($260.62/year), transportation ($323.26/y), accommodation ($177.16/y), other cost ($40.21/y). Peripheral articular involvement (OR=2.412, 95%CI: 1.006~4.562, P=0.048) and disease duration (OR=0.197, 95%CI: 0.056~0.693, P=0.011) showed the most important influence on the total medicine cost.

Conclusion: SF-36 can objectively reflected the QoL of Chinese patients with AS. PROs such as BASDAI and BASFI showed great application value in this prospective cohort study of AS patients.  High medicine cost directly increased the economical burden of AS patients. Peripheral articular involvement and disease duration showed the most important influence on the total medicine cost. Other indirect cost related with the therapies also increased the economical burden of AS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-reported-outcomes-measures-and-economical-burden-of-patients-with-ankylosing-spondylitis-in-a-chinese-prospective-cohort-with-smart-management-system-for-spondyloarthritis/