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Abstract Number: 1159

Long-Term Quality of Life, Productivity Impairment, Disease Severity and Health Care Costs in Relation to Functional Impairment in Ankylosing Spondylitis Patients in the Czech Republic

Liliana Sedova1,2, Monika Urbanova3, Jiri Stolfa2,3, David Suchy4, Andrea Smrzova5, Tomas Mlcoch6, Jiri Klimes7 and Tomas Dolezal7, 1rheumatology, Institute of Rheumatology, Prague, Czech Republic, 2Clinic of Rheumatology, Charles University Prague, Prague, Czech Republic, 3Inpatients´ Clinic, Institute of Rheumatology Prague, Prague, Czech Republic, 4Department of Clinical Pharmacology, Rheumatology, University hospital Plzen, Plzen, Czech Republic, 53rd internal clinic, University hospital Olomouc, Olomouc, Czech Republic, 6Institute of Health Economics and Technology Assessment, Prague, Dominica, 7Institute of Health Economics and Technology Assessment, Charles University, Prague, Czech Republic

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Ankylosing spondylitis (AS), Biologic agents, functional status, health care cost and quality of life

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Session Information

Session Title: Health Services Research

Session Type: Abstract Submissions (ACR)

Background/Purpose

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 in three-year follow-up. These are follow-up results; the first visit was presented in ACR 2013.

Methods

This is a prospective multicenter non-interventional observational study with AS patients in 4 specialized centers for treatment of rheumatic diseases in the Czech Republic. A three-year follow-up with 6 months period between each time point observation is ongoing. The data presented here comes from the first visit and three subsequent visits (i.e. time 0, 6, 12 and 18 months). The demographic, clinical, QoL and productivity data were directly collected from patients. Health care consumption was assessed retrospectively reviewing individual patient’s medical record. 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. Patients were stratified according to their BASFI into 10 categories. Within health care consumption directly related to AS, we focus on medication, out-patient & in-patient care, complement, examination and out-of pocket expenses. Health care expenditures are presented as average yearly costs per patient. Patients were analyzed as the whole cohort and specifically by the presence of biologic treatment.

Results

291 patients with AS were registered at the first visit, 218 on biological drugs, mean age was 44.3 years, mean time from diagnoses was 13.6 years, 26.1% were female. With higher functional impairment, described by BASFI, there is a 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 higher BASFI. See the results in table 1 & 2; values presented as mean, n.a.-not applicable.

Conclusion

Patients with worse functional impairment revealed more significant impairment of their QoL, work productivity and revealed also worse clinical outcomes and higher costs (in non-biologic treated patients). There is a trend of decreasing number of work active patients who are not on biologics. For patients not treated with biologics, BASFI is a very good cost predictor.

Acknowledgement: Supported by the Research program of the Ministry of Health of Czech Republic IGA MZ CR: No. 000 000 23728

Table 1: Initial visit of AS patients

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

52

38.0

9.8

31%

12,074

88%

6%

1.2

0.894

1-2>

1.5

42

40.8

11.9

21%

11,157

81%

21%

1.6

0.780

2-3>

2.5

35

46.2

15.3

14%

12,069

74%

27%

2.1

0.722

3-4>

3.4

29

44.6

15.1

24%

10,960

66%

27%

2.2

0.670

4-5>

4.4

23

44.5

14.9

22%

12,315

57%

40%

2.1

0.651

5-6>

5.4

20

44.8

17.9

20%

11,151

50%

41%

2.5

0.624

6-7>

6.5

7

46.4

7.1

29%

13,408

57%

23%

7.1

0.613

7-8>

7.5

2

66.5

27.0

0%

7,100

50%

70%

2.8

0.623

8-9>

8.5

6

51.0

15.5

0%

14,294

33%

40%

3.0

0.583

9-10>

9.2

2

50.5

18.5

50%

11,309

50%

95%

3.4

0.429

Mean/total

2.8

218

43.0

13.4

22%

11,740

72%

22%

2.0

0.740

Patients without 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

15

40.6

9.5

40%

174

80%

26%

1.9

0.838

1-2>

1.6

9

45.2

8.2

44%

327

89%

37%

2.4

0.746

2-3>

2.4

8

45.8

7.6

50%

221

63%

16%

2.5

0.682

3-4>

3.6

8

49.0

16.6

63%

354

75%

36%

2.5

0.614

4-5>

4.4

8

49.9

16.6

38%

290

50%

28%

2.9

0.583

5-6>

5.4

10

54.9

18.5

20%

645

70%

53%

3.3

0.603

6-7>

6.3

3

52.7

18.7

33%

348

67%

35%

3.0

0.608

7-8>

7.4

6

52.0

20.0

17%

665

50%

51%

2.9

0.530

8-9>

8.6

6

52.5

23.0

17%

1,593

0%

n.a.

8.4

0.392

9-10>

n.a.

n.a.

n.a.

n.a.

n.a.

n.a.

n.a.

n.a.

n.a.

n.a.

Mean/total

3.7

73

48.0

14.3

37%

459

64%

34%

3.1

0.653

Whole patient cohort

BASFI category

BASFI

No.

Age

Time from Dx (years)

% women

Costs (EUR)

% of work active

% WPAI

ASDAS-CRP

EQ-5D

Mean/total

3.0

291

44.3

13.6

26%

8,910

70%

25%

2.3

0.718

Table 2: Follow-up observations

1st visit

2nd visit

3rd visit

4th visit

Mean/total

Bio

w/o Bio

Whole

Bio

w/o Bio

Whole

Bio

w/o Bio

Whole

Bio

w/o Bio

Whole

BASFI

2.8

3.7

3.0

2.7

4.3

2.9

2.5

4.0

2.7

2.7

n.a.

2.8

No. (% of work active)

218 (72%)

73 (64%)

291 (70%)

185 (72%)

23 (65%)

208 (71%)

152 (75%)

22 (59%)

 174 (73%)

64 (70%)

n.a.

66 (70%)

% WPAI

22%

34%

25%

19%

26%

19%

21%

23%

21%

23%

n.a.

23%

ASDAS-CRP

2.0

3.1

2.3

1.8

2.6

1.9

1.8

2.6

1.9

1.8

n.a.

1.8

EQ-5D

0.740

0.653

0.718

0.738

0.667

0.730

0.744

0.638

0.731

0.726

n.a.

0.723

Bio – patients on biologic treatment; w/o – patients without biologic treatment; Whole – Whole cohort of patients


Disclosure:

L. Sedova,
None;

M. Urbanova,
None;

J. Stolfa,
None;

D. Suchy,
None;

A. Smrzova,
None;

T. Mlcoch,
None;

J. Klimes,
None;

T. Dolezal,
None.

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