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 |
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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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