OBJECTIVES: The COVID-19 pandemic significantly impacted on mental health both in the general population and in specific vulnerable subgroups. In particular, patients with rheumatic and musculoskeletal diseases (RMDs) have been shown to be more vulnerable, as they experienced difficulties in the management of disease, and might have severe psychological consequences that might impact on the economic burden of disease. The present study aims to explore the impact of post-traumatic stress disorders (PTSD) on the economic burden of RMDs during the COVID-19 pandemic in Italy.

METHODS: As part of the activities of the PERMAS prospective observational project information about resources used related to direct (i.e., direct health costs, out-of-pocket expenses and other direct non-health costs) and indirect costs were collected from RMDs patients enrolled from May 2021 to April 2022. Direct costs were estimated based on national tariffs while costs for informal assistance and productivity losses were estimated respectively using the proxy-good method and the human capital approach and referred to 2021.We analysed the impact of PTSD (assessed using Trauma and Loss Spectrum- Self Report scale) on costs with a two-part model using a probit model for the first part and a gamma distribution and log link in the second part and adjusting for age, gender, type of RM disease and education level.

RESULTS: Out of 237 patients considered in the analysis, 126 (53.2%) reported a PTSD. Overall, total costs related to disease were 2583€(0;40,529) per patient/year and costs were about 29% higher in patients with PTSD. Indeed results from the two-part model showed that the amount of costs related to the disease significantly increased in patients with PTSD (β=0.448(0.162), p-value<0.001) independently of age, gender, type of RM disease, education level.

CONCLUSIONS: The impact COVID-19 has had on mental health of RMDs patients has the potential to impact also on the economic burden of disease.