Background/Purpose:

Our aim was to describe the QoL, productivity impairment, clinical indicators and health care costs in relationship to functional status described by Health assessment questionnaire (HAQ) in Psoriatic arthritis 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 Psoriatic arthritis (PsA) patients in 4 specialized centres for treatment of rheumatic diseases in the Czech Republic. There is 3 years of follow-up planned with 6 months period between each time point observation. The data presented here comes from the first visit, where demographics, clinical, QoL data and productivity 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 DAPsA, QoL measured by EuroQol questionnaire (EQ-5D), work impairment by Work Productivity and Activity Impairment (WPAI) in relationship to HAQ categories. Validated Czech versions of all questionnaires were used. Patients are stratified according to their HAQ in 6 categories, i.e. 0 – 0.5>, 0.5 – 1.0>, 1.0 – 1.5>, 1.5 – 2.0>, 2.0 – 2.5>, 2.5 – 3.0>. 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 money. 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 164 patients with PsA, 63 on biological drugs, mean patient age was 57.3 years, mean time from diagnoses of PsA was 25.9 years, 52% were female. With higher functional impairment, described by HAQ, there is an increase in age, time from diagnoses, percentage of work impairment and also decrease in work-active patients. There is also deterioration in clinical impairment (DAPsA) and QoL observed with worse functional status. There is almost the same height of total costs in each HAQ category in the cohort of patients treated with biologics, as these drugs are the biggest costs driver. However, there is a cost increase in the category with highest HAQ in the cohort not treated with biologics. See results table, where all values are presented as mean values, n.a. – not applicable.

Conclusion:

Patients with worse functional impairment (based on HAQ) revealed 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 HAQ impairment (i.e. HAQ > 2.0) must be interpreted with caution because of lower number of patients in these categories.

Patients on biologic drugs
HAQ category	HAQ	No.	Age (Years)	Time from Dx(Years)	% women	Costs (EUR)	% of   work-active	% WPAI	DAPsA	EQ-5D
0-0.5>	0.2	28	48.0	22.0	39.3%	11,481	82.1%	18.0%	7.5	0.830
0.5-1.0>	0.8	12	51.8	25.5	50.0%	11,604	58.3%	24.9%	8.5	0.733
1.0-1.5>	1.2	10	51.3	25.2	60.0%	12,375	30.0%	45.3%	13.7	0.607
1.5-2.0>	1.8	10	62.7	29.3	40.0%	10,303	10.0%	50.0%	21.2	0.510
2.0-2.5>	2.4	3	59.7	34.3	66.7%	13,181	33.3%	0.0%	32.5	0.375
2.5-3.0>	n.a.	0	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.
Mean/total	0.83	63	52.1	24.9	46.0%	11,482	55.6%	27.9%	12.0	0.704
Patients without biologic drugs
HAQ category	HAQ	No.	Age	Time from Dx(Years)	% women	Costs (EUR)	% of   work-active	WPAI %	DAPsA	EQ-5D
0-0.5>	0.1	51	56.6	24.9	43.1%	301	66.7%	14.0%	9.1	0.788
0.5-1.0>	0.9	22	63.0	26.8	68.2%	481	36.4%	26.3%	13.3	0.649
1.0-1.5>	1.3	20	62.7	28.7	55.0%	542	10.0%	40.0%	18.0	0.527
1.5-2.0>	n.a.	0	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.
2.0-2.5>	2.3	3	73.7	41.3	100.0%	411	0.0%	n.a.	24.5	0.381
2.5-3.0>	2.8	5	72.2	23.6	100.0%	1,218	0.0%	n.a.	24.8	0.216
Mean/total	0.73	101	60.5	26.5	55.4%	400	43.6%	20.7%	13.0	0.665
Whole cohort of patients
HAQ category	HAQ	No.	Age	Time from Dx(Years)	% women	Costs (EUR)	% of   work-active	WPAI %	DAPsA	EQ-5D
0-0.5>	0.2	79	53.6	23.8	41.8%	4,264	72.2%	15.5%	8.5	0.803
0.5-1.0>	0.9	34	59.1	26.3	61.8%	4,407	44.1%	25.7%	11.6	0.679
1.0-1.5>	1.3	30	58.9	27.5	56.7%	4,486	16.7%	43.2%	16.6	0.554
1.5-2.0>	1.8	10	62.7	29.3	40.0%	10,302	10.0%	50.0%	21.2	0.510
2.0-2.5>	2.4	6	66.7	37.8	83.3%	6,796	16.7%	0.0%	28.5	0.378
2.5-3.0>	2.8	5	72.2	23.6	100.0%	1,218	0.0%	n.a.	24.8	0.216
Mean/total	0.80	164	57.3	25.9	51.8%	4,657	48.2%	23.7%	12.6	0.680

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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-psoriatic-arthritis-patients-in-the-czech-republic/