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PAR1 |
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ARE THEY RELEVANT? A
CRITICAL EVALUATION OF THE INTERNATIONAL
CLASSIFICATION OF FUNCTIONING, DISABILITY AND
HEALTH CORE SETS FOR OSTEOARTHRITIS FROM THE
PERSPECTIVE OF PATIENTS WITH KNEE OSTEOARTHRITIS
IN SINGAPORE
Xie F1, Thumboo J2, Fong KY2, Lo NN2, Yeo
SJ2, Yang KY2, Li SC1, 1National University of
Singapore, Singapore, 2Singapore General Hospital,
Singapore OBJECTIVE:
To determine the extent to which health items
identified from the perspective of patients with
knee osteoarthritis can be linked with the ICF;
and to critically evaluate the ICF Comprehensive
and Brief Core Sets for osteoarthritis.
METHODS:
Items identified from a focus group study were linked independently by two
researchers based on the 10 a priori linking
rules. Both percentage agreement and kappa
statistics were calculated to measure
inter-observer agreement. Any disagreements were
resolved by reaching a consensus among the
researchers. The categories linked with all items
were compared with the Comprehensive Core Set,
while the categories linked with those items
reported as important by over 30% of subjects
within each of three local ethnic groups (Chinese,
Malay, and Indian) were compared with the Brief
Core Set. Both comparisons were made only at the
second level of the ICF.
RESULTS:
Totally 74 items were linked with 44 different ICF categories through 105
linkages with generally very good inter-observer
agreement. The 69 items were linked with the ICF
at the third or fourth levels. Both commonalities
and disparities were found through comparison
between the categories linked with these items and
both Core Sets for osteoarthritis. CONCLUSIONS:
All items could be successfully linked with the
ICF. The Comprehensive Core Set demonstrated
general conceptual validity, while the Brief Core
Set needs to be supported by more empirical
evidence in various socio-cultural contexts. This
study specifically complemented the development
and refinement of both Core Sets from the
perspective of patients with knee osteoarthritis.
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PAR2 |
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COST-EFFECTIVENESS
ANALYSIS OF TREATMENT OPTIONS FOR METHOTREXATE-RESISTANT
RHEUMATOID ARTHRITIS IN KOREA
Lee EK1, Park EJ1, Sung YK2, Park SJ1, Kim
JJ3, Bae SC2, 1Korea Institute for Health and
Social Affairs (KIHASA), Seoul, South Korea,
2Hanyang University Hospital, Seoul, South Korea,
3Sook-myung Women’s University, Seoul, South Korea
OBJECTIVE:
Treatment options for rheumatoid arthritis (RA) have become diverse in
Korea since the introduction of new
disease-modifying antirheumatic drugs (DMARDs)
such as etanercept. This study aimed to analyze
the cost-effectiveness of the major treatment
options for methotrexate (MTX)-resistant
rheumatoid arthritis in Korea with a time horizon
of six months. METHODS:
A cost-effectiveness analysis was performed to compare six major strategies
in Korean medical practice for patients with MTX-resistant
RA : 1) MTX only, 2)Etanercept only, 3)Etanercept
+MTX, 4)Cyclosporin+MTX, 5)Leflunomide(20mg) only,
6)Leflunomide(10mg)+ MTX. Data for efficacy for
the patients with methotrexateresistant rheumatoid
arthritis were extracted from the published
clinical trials searched from Pubmed. ACR20 were
employed as the measurements of effectiveness. The
direct medical costs including medication cost,
monitoring and dispensing cost were estimated
based on Korean National Health Insurance
reimbursement fee schedule. RESULTS:
Etanercept monotherapy, Cyclosporin+MTX, and
Leflunomide(20mg) monotherapy cost more, but
either were not more efficacious or had a high
incremental CE ratio than the next most expensive
option (i.e., they were dominated). For the least
expensive option, Leflunomide(10mg)+MTX, ICER with
MTX monotherapy was 2,066,000 Won (Korean
currency)/ ACR 20. The most efficacious option,
Etanercept+MTX showed the ICER of 29,634,000 Won
per ACR20 response. CONLUSIONS:
Leflunomide+MTX was evaluated as a cost effective option for MTX resistant
RA in achieving ACR20 over a 6 month period. The
most efficacious option, Etanercept+MTX, incurs
much higher incremental costs per ACR20 than other
options analyzed. Whether Etanercept+MTX compared
with MTX is cost effective depends on whether ICER
value over a six month period is considered
acceptable. In the future, it is also needed to
analyses long-term cost effectiveness using Markov
modeling and to include indirect cost for RA in
order to apply for health insurance policy.
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PAR3 |
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DIRECT MEDICAL COST OF
RHEUMATOID ARTHRITIS IN HONG KONG
Lee VWY1, Lee KK1, Li EK2, Chan CW1, Chan
LH1, Ng TS1, Tam LS2, 1The Chinese University of
Hong Kong, Shatin, Hong Kong, China,
2Rheumatology/Faculty of Medicine, The Chinese
University of Hong Kong, Shatin, Hong Kong, China
OBJECTIVE:
To evaluate the direct medical cost in the management of rheumatoid
arthritis (RA) as well as the extent of resource
use in current practice from the perspective of
public health organization in Hong Kong.
METHODS:
This study was a retrospective design. Subjects recruited must have RA
diagnosed and attended the follow-up visits,
receiving RA treatment in the Prince of Wales
Hospital (PWH) between the period of 1st January
2002 to December 31, 2002. Data was collected by
medical chart review. The direct medical costs
included inpatient care, outpatient visits,
laboratory monitoring, radiological procedure,
drug cost and side effects management.
RESULTS:
A total of 147 patients were included in our study. The average age and the
duration of disease of our subjects were 54.7
years old (SD: 10.9) and 12.6 year (SD: 7.0)
respectively. The annual direct medical cost per
each RA patient was HK$18,657 (US $ 1 = HK $ 7.8).
The inpatient care contributed 43.8% of the total,
which was the highest. The cost for laboratory
monitoring was the second (19.2%) where the
outpatient cost ranked the third (15.4%). The cost
for RA-related drugs accounted for 9.8%. The cost
for the management of the side effects shared 3.1%
of the total. Based on a local epidemiological
study, the RA prevalence rate was 0.3%. The annual
direct medical cost for the management of RA in
Hong Kong would be HK$443 million, which shared
1.4% of the total healthcare budget in 2002.
CONLUSIONS:
This study demonstrated that RA was a significant
economic burden to the healthcare budget of Hong
Kong.
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PAR4 |
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RELATIONSHIP BETWEEN
HEALTH-RELATED QUALITY OF LIFE AND CLINICAL
IMPAIRMENT IN TAIWANESE PATIENTS WITH RHEUMATOID
ARTHRITIS
Lin HY1, Huang VWH2, Tarn TH3, Su KYJ4,
Huang KYC4, 1Taipei Veterans General Hospital,
Taipei, Taiwan, 2Protech Pharmaservices
Corporation, Taipei, Taiwan, 3Taipei City
Hospital, Taipei, Taiwan, 4Protech Pharmaservices
Corporation, Taipei, Taiwan OBJECTIVE:
Improvements in disease-related symptoms and health-related quality of life
(HRQoL) are the desired key outcomes of medical
management in rheumatoid arthritis (RA). The
relationship between quality of life and clinical
impairment must therefore be investigated.
METHODS:
A total 225 RA patients (87% female; mean age 54 years) were enrolled
prospectively from October 2004 to March 2005.
Patients were evaluated with a generic
questionnaire, Short-Form 36 (SF-36), quality of
life instruments, the Health Assessment
Questionnaire (HAQ) Disability Index and the HAQ
pain scale, as well as the 28 joint Disease
Activity Score (DAS28) measuring functional
activity and functional impairment. Multivariate
regression analyses were used to identify factors
predicting HAQ scores. RESULTS:
Among the 225 patients, 25% were inactive, 40% were moderately active and
35% were very active. The low scores on the HAQ
pain scale may be because the fact that the
majority of patients were receiving medication.
HAQ scores were moderately correlated with DAS28
scores (r=0.60, p<0.0001) and SF-36 PCS(r=-0.70,
p<0.0001) but only weakly correlated with SF-36
MCS (r=-0.39, p<0.0001). In addition, regression
analyses showed that SF-36 PCS, MCS, and DAS28
scores were significantly contributors to the
prediction of HAQ Index score (R2 = 0.59, p <
0.001). CONLUSIONS:
Our data indicate that currently used clinical endpoints do not fully
assess the quality of life in RA patients.We
suggest that multidimensional scales may
significantly improve the measurement precision
and accuracy of QOL instruments. |
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PAR5 |
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DIRECT MEDICAL COST OF
ANKYLOSING SPONDYLITIS IN SOUTHERN CHINESE
Tam LS1, Li EK1, So SW2, Chan BM2, Kan KW2, Hwang
WW1, Lee KK2, Lee VWY2,
1Rheumatology/Faculty of Medicine, The Chinese
University of Hong Kong, Shatin, Hong Kong, China,
2The Chinese University of Hong Kong, Shatin, Hong
Kong, China OBJECTIVE:
To determine the direct medical cost of ankylosing spondylitis (AS) in Hong
Kong according to disease severity based on the
Bath Ankylosing Spondylitis Disease Activity Index
(BASDAI) score. METHODS:
This is a retrospective, cross-sectional
study. Subjects were recruited from the
rheumatology clinic. Information on the public
care was collected by chart review. A special
questionnaire to elicit patients of demographic,
clinical, current disease state, health-care and
private resource consumption related to AS over
the previous 12 months period was completed during
a telephone interview. RESULTS:
The mean SD age of the 70 subjects was 41.4 ± 11.3 years. The male to
female ratio was 3: 1, with mean disease duration
of 9.6/8.0 years. The median (interquartile range
(IQR)) BASDAI score was 4.8 (3.4 - 6.7).
Forty-nine percent of patients had active disease
with BASDAI ³a 5 (group 1) and 51% had less active
disease with BASDAI < 5 (group 2). The median
total direct cost per AS patient per year was
significantly higher in group 1 (HK$12,355 (9,250
- 20,690) compared with group 2 (HK$ 8,488
(6,319-11,615)) (p=0.01). This was mainly due to a
significantly higher cost to the government in
group 1 (HK$ 12,135 (8,920 - 19,980) compared to
group 2 (HK$ 8,293 (6,063- 11,073) (p=0.01). Three
patients were hospitalized last year in group 1.
The outpatient cost was also significantly higher
in group 1 (HK$11,475 (8,770-19,980)) compared to
group 2 (HK$8,293 (6,062-11,072)) (p=0.02). The
patients of total out of pocket cost were
significantly higher in group 1 (HK$ 400 (310-840)
compared to group 2 HK$ 265 (192-355)(p=0.13).
CONLUSIONS:
Ankylosing spondylitis patients with high disease activity appear to
require more in-patient and out-patient care,
resulting in higher medical costs than those with
less severe disease. |
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