Counting Costs under Severe Financial Constraints: A Cost-of-Illness Analysis of Spondyloarthropathies in a Tertiary Hospital in Greece

Niki Tsifetaki; Michail P Migkos; Charalampos Papagoras; Paraskevi V Voulgari; Kostas Athanasakis; Alexandros A Drosos

doi:10.3899/jrheum.141277

Counting Costs under Severe Financial Constraints: A Cost-of-Illness Analysis of Spondyloarthropathies in a Tertiary Hospital in Greece

J Rheumatol. 2015 Jun;42(6):963-7. doi: 10.3899/jrheum.141277. Epub 2015 Apr 1.

Authors

Niki Tsifetaki¹, Michail P Migkos¹, Charalampos Papagoras¹, Paraskevi V Voulgari¹, Kostas Athanasakis¹, Alexandros A Drosos²

Affiliations

¹ From the Department of Rheumatology, General Hospital "G. Hatzikosta"; Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina; Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace, Alexandroupolis; Department of Health Economics, National School of Public Health, Athens, Greece.N. Tsifetaki, MD, Consultant Rheumatologist, Department of Rheumatology, General Hospital "G. Hatzikosta"; M.P. Migkos, MD, Fellow in Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; C. Papagoras, MD, PhD, Rheumatologist, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, and Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace; P.V. Voulgari, MD, Associate Professor of Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; K. Athanasakis, PhD, Research Fellow, Department of Health Economics, National School of Public Health; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina.
² From the Department of Rheumatology, General Hospital "G. Hatzikosta"; Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina; Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace, Alexandroupolis; Department of Health Economics, National School of Public Health, Athens, Greece.N. Tsifetaki, MD, Consultant Rheumatologist, Department of Rheumatology, General Hospital "G. Hatzikosta"; M.P. Migkos, MD, Fellow in Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; C. Papagoras, MD, PhD, Rheumatologist, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, and Laboratory of Molecular Hematology, Medical School, Democritus University of Thrace; P.V. Voulgari, MD, Associate Professor of Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina; K. Athanasakis, PhD, Research Fellow, Department of Health Economics, National School of Public Health; A.A. Drosos, MD, FACR, Professor of Medicine/Rheumatology, Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina. adrosos@cc.uoi.gr.

PMID: 25834213
DOI: 10.3899/jrheum.141277

Abstract

Objective: To investigate the total annual direct cost of patients with spondyloarthritis (SpA) in Greece.

Methods: Retrospective study with 156 patients diagnosed and followed up in the rheumatology clinic of the University Hospital of Ioannina. Sixty-four had ankylosing spondylitis (AS) and 92 had psoriatic arthritis (PsA). Health resource use for each patient was elicited through a retrospective chart review that documented the use of monitoring visits, medications, laboratory/diagnostic tests, and inpatient stays for the previous year from the date that the review took place. Costs were calculated from a third-party payer perspective and are reported in 2014 euros.

Results: The mean ± SD annual direct cost for the patients with SpA reached €8680 ± 6627. For the patients with PsA and AS, the cost was estimated to be €8097 ± 6802 and €9531 ± 6322, respectively. The major cost was medication, which represented 88.9%, 88.2%, and 89.3% of the mean total direct cost for SpA, AS, and PsA, respectively. The annual amount of the scheduled tests for all patients corresponded to 7.5%, and for those performed on an emergency basis, 1.1%. Further, the cost for scheduled and emergency hospitalization, as well as the cost of scheduled visits to an outpatient clinic, corresponded to 2.5% of the mean total annual direct cost for the patients with SpA.

Conclusion: SpA carries substantial financial cost, especially in the era of new treatment options. Adequate access and treatment for patients with SpA remains a necessity, even in times of fiscal constraint. Thus, the recommendations of the international scientific organizations should be considered when administering high-cost drugs such as biological treatments.

Keywords: ANKYLOSING SPONDYLITIS; ANNUAL COST; DIRECT COST; PSORIATIC ARTHRITIS; SPONDYLOARTHROPATHIES.

MeSH terms

Adult
Aged
Antibodies, Monoclonal, Humanized / administration & dosage
Antibodies, Monoclonal, Humanized / economics*
Antirheumatic Agents / economics*
Antirheumatic Agents / therapeutic use
Arthritis, Psoriatic / diagnosis
Arthritis, Psoriatic / drug therapy
Arthritis, Psoriatic / economics*
Cohort Studies
Cost of Illness*
Cost-Benefit Analysis
Female
Greece
Hospital Costs
Humans
Insurance, Health, Reimbursement / economics*
Male
Middle Aged
Retrospective Studies
Severity of Illness Index
Spondylarthropathies / diagnosis
Spondylarthropathies / drug therapy
Spondylarthropathies / economics*
Tertiary Care Centers

Substances

Antibodies, Monoclonal, Humanized
Antirheumatic Agents