Background/Purpose: Our aim was to describe the quality-of-life (QoL), productivity impairment, clinical indicators and health care costs in relationship to functional status described by Bath Ankylosing Spondylitis Functional Index (BASFI) in Ankylosing spondylitis (AS) patients. This relationship is highly important to justify the investment into health care.

Methods: We have organized a prospective multicentre non-interventional observational study with AS patients in 4 specialized centres for treatment of rheumatic diseases in the Czech Republic. A three-year follow-up is planned with 6 months period between each time point observation. The data presented here comes from the first visit, where demographics, clinical, QoL and productivity data were directly collected from patients. Health care consumption was assessed retrospectively reviewing individual patient’s medical record (with 6 or 12 months recall period from the first visit). Clinical data were described by ASDAS-CRP, QoL measured by EuroQol questionnaire (EQ-5D), work impairment by Work Productivity and Activity Impairment (WPAI) with respect to BASFI categories. Validated Czech versions of all questionnaires were used. Patients are stratified according to their BASFI in 10 categories. Within health care consumed, we focus on medication (classical DMARDs, corticosteroids and biological drugs), out-patient & in-patient care, complement and instrumental examination and out-of pocket expenses. Health care expenditures are annualized and presented as an average costs per patient. Patients are analysed as the whole cohort and specifically by the presence of biologic treatment.

Results: We have already included 225 patients with AS, 200 on biological drugs, mean patient age was 43.4 years, mean time from diagnoses of AS was 13.8 years, 24.4% were female. With higher functional impairment, described by BASFI, there is trend in age increase, increase in time from diagnosis, percentage of work impairment and also decrease in percentage of work-active patients. There is also deterioration in clinical impairment (ASDAS-CRP) and QoL observed with worse functional status. There is almost the same height of total costs in each BASFI category as 89% of all patients are treated with biologics, which are the most important costs driver. See results table, where all values are presented as mean values, na – not applicable.

Patients on biologic drugs
BASFI category	BASFI	No.	Age	Time from Dx (years)	% women	Costs (EUR)	% of work active	% WPAI	ASDAS-CRP	EQ-5D
0-1>	0.4	50	38.0	9.8	32.0%	12,733	88.0%	6.1%	1.2	0.900
1-2>	1.5	40	41.1	11.7	22.5%	11,960	82.5%	21.4%	1.6	0.782
2-3>	2.5	34	46.1	15.3	14.7%	13,371	73.5%	26.0%	2.1	0.731
3-4>	3.4	23	44.9	16.2	26.1%	11,866	69.6%	23.8%	2.3	0.668
4-5>	4.5	20	44.0	16.3	30.0%	13,551	55.0%	34.0%	1.9	0.661
5-6>	5.4	15	45.2	17.9	20.0%	11,894	46.7%	36.6%	2.4	0.656
6-7>	6.6	7	42.4	7.7	14.3%	12,621	57.1%	47.5%	2.6	0.665
7-8>	7.3	4	52.5	18.3	0.0%	11,397	75.0%	68.9%	3.1	0.651
8-9>	8.4	5	47.8	18.6	0.0%	15,287	20.0%	40.0%	3.5	0.501
9-10>	9.3	2	46.0	13.5	0.0%	12,479	50.0%	95.3%	3.0	0.521
Mean/total	2.7	200	42.7	13.5	23.0%	12,637	72.5%	21.9%	1.9	0.752
Patients without biologic drugs
BASFI category	BASFI	No.	Age	Time from Dx (years)	% women	Costs (EUR)	% of work active	% WPAI	ASDAS-CRP	EQ-5D
Mean/total	4.2	25	49.0	16.6	36.0%	483	52.0%	34.1%	2.9	0.596
Whole patient cohort
BASFI category	BASFI	No.	Age	Time from Dx (years)	% women	Costs (EUR)	% of work active	% WPAI	ASDAS-CRP	EQ-5D
0-1>	0.4	53	37.6	9.5	32.1%	12,026	84.9%	6.7%	1.2	0.899
1-2>	1.5	44	41.5	11.3	25.0%	10,898	84.1%	23.6%	1.7	0.772
2-3>	2.5	37	46.2	14.7	18.9%	12,303	73.0%	25.2%	2.1	0.724
3-4>	3.4	26	46.3	17.4	30.8%	10,534	69.2%	24.9%	2.3	0.664
4-5>	4.5	22	44.0	17.0	27.3%	12,370	59.1%	33.2%	2.0	0.656
5-6>	5.4	19	48.9	19.3	21.1%	9,528	47.4%	37.3%	2.6	0.621
6-7>	6.6	7	42.4	7.7	14.3%	12,621	57.1%	47.5%	2.6	0.665
7-8>	7.4	6	49.3	14.5	0.0%	8,134	50.0%	68.9%	3.3	0.608
8-9>	8.5	9	50.0	22.4	11.1%	8,684	11.1%	40.0%	3.7	0.444
9-10>	9.3	2	46.0	13.5	0.0%	12,479	50.0%	95.3%	3.0	0.521
Mean/total	2.9	225	43.4	13.8	24.4%	11,286	70.2%	22.7%	2.0	0.734

Conclusion: Patients with worse functional impairment revealed more significant impairment of their QoL, work productivity and revealed also worse clinical outcomes. We present total health care costs according to the functional impairment. The findings attributed to higher BASFI impairment (BASFI > 6.0) and to patients not treated with biologics should be interpreted with caution because of lower number of patients in these categories.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quality-of-life-productivity-impairment-disease-severity-and-health-care-costs-in-relation-to-functional-impairment-in-ankylosing-spondylitis-patients-in-the-czech-republic/