Trends in economic consequences of rheumatoid arthritis over two subsequent years.

OBJECTIVE: To examine changes in direct costs and in working status over 2 yrs in patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: In both 1999 and 2000, RA patients (n = 461) filled out a questionnaire retrospectively regarding utilization of health care, other RA-related direct costs and working status. Patients were categorized into four disease duration groups: 0-2 yrs, 2-6 yrs, 6-10 yrs and >10 yrs. At the same time points, disease activity was assessed. Logistic regression analyses were performed to identify a possible association between disease activity (high >66th percentile) measured at start of the second year and high direct costs (high >66th percentile) in the second year. RESULTS: Compared with the first year, a significant decrease in the costs for contacts with health care workers and for costs for laboratory tests was observed in the second year for the <2 yrs group. In the 2-6 yrs group and the >10 yrs group, we found a significant decrease in costs for devices and adaptations, but medication costs increased in the <2 yrs and the >10 yrs group in the second year. In the >10 yrs group, this was mainly due to an increasing number of patients who started to use biological agents during the second year. In all four disease duration groups, worse Visual Analogue Scale (VAS) disease activity and VAS general well-being were significantly associated with high direct costs. Of 97 patients working without disability at time of the first assessment, 12 (12%) patients became (partial) work disabled during follow-up. CONCLUSION: In particular, costs for devices/adaptations and for medication changed during follow-up. The latter was probably due to an increase in the use of biological agents. Hopefully a decrease in direct costs and a reduced percentage of patients getting work disabled by better disease control will outweigh the high costs of biological drugs in the future.

Productivity costs among patients with rheumatoid arthritis: the influence of methods and sources to value loss of productivity.

OBJECTIVE: To assess productivity costs incurred by rheumatoid arthritis, comprising paid as well as household productivity costs, from a societal perspective, using different methods. METHODS: A questionnaire on productivity, including items of the Health and Labour Questionnaire, was completed by 576 patients with rheumatoid arthritis (mean disease duration seven years). The friction cost (FC) method using the gross national wage per hour was applied to estimate paid productivity, and the market equivalent was used to value loss of household productivity. Sensitivity analyses to estimate paid productivity costs among patients of working age included the human capital (HC) method and an alternative source, namely the "added value", to value loss of paid productivity. RESULTS: In the total study population, mean (SD) annual costs from loss of paid productivity according to the FC method were estimated to be 278 (1,559) and mean annual household productivity costs were 2,045 (3,882). When using the HC method, mean annual costs increased to an average of 4,434 (9,957). When using the added value of production, average FC costs increased from 455 to 540 among patients of working age. CONCLUSIONS: Costs from loss of household productivity in rheumatoid arthritis were seven times higher than costs from loss of paid productivity, assessed by the FC method. The high paid productivity costs when using the HC method reflect the high work disability rate in rheumatoid arthritis. As the method of measuring and source of valuing productivity loss has an important influence on the costs, a consensus to standardise these issues is desirable.

Working status among Dutch patients with rheumatoid arthritis: work disability and working conditions.

OBJECTIVES: To assess work disability and variables associated with work disability among Dutch patients with rheumatoid arthritis (RA). METHODS: A questionnaire on working status was filled out by 296 patients of working age. Employment and work disability rates adjusted for age and sex from the Dutch population were determined using indirect standardization. Cox proportional hazard analysis was used to assess baseline predictors of work disability in a subgroup of patients (n = 195). RESULTS: After a mean disease duration of 4.3 yr, patients had a 0.78 (95% CI 0.67-0.88) chance of being employed and a 2.14 (95% CI 1.75-2.54) risk of being work disabled when compared with the Dutch population. Functional disability and job type at the start of the disease were predictors of future work disability. In total, 48 (37%) currently employed patients had changed their working conditions, of which reduced working hours (46%), reduced pacing of work (42%) and help from colleagues (49%) were the most important alterations. Of the 60 work disabled patients without a paid job, only 11 patients (18%) would be willing to work again. CONCLUSION: This study shows that the adjusted employment rates were lower and that work disability rates were higher in patients with RA when compared with the general Dutch population. In addition, a substantial number of employed patients had to change their working conditions due to RA. Only a minority of work disabled RA patients was willing to return to the paid labour force.

Determinants of direct costs in Dutch rheumatoid arthritis patients.

OBJECTIVES: To estimate annual direct costs in four distinct disease duration groups (0 to < or =2, 2 to < or =6, 6 to < or =10, and >10 years) of patients with rheumatoid arthritis (RA), to determine predictors of high costs and to describe characteristics of patients with high and with low costs. METHODS: A questionnaire assessing RA related care and resource utilisation rates and costs was completed by 615 RA patients. Predictive variables for incurred costs, as observed during the first year after disease onset, were determined in a subgroup of patients (n = 347). RESULTS: Mean (median) annual direct costs for the four groups with increasing disease duration were respectively: 5235 (2923) Euros, 3930 (1968) Euros, 4664 (1952)Euros, and 8243 (3778) Euros, (p < 0.05). During the first 2 years of the disease total direct costs comprised mainly of consultations with healthcare workers (28%). After 10 years, devices and adaptations were the main contributors (40%) to total costs. Positive rheumatoid factor results at the time of diagnosis and deterioration of functional disability in the first year of disease were predictors of high costs later on in the course of the disease. CONCLUSION: Annual direct costs among patients with a disease duration of less than 2 years tend to be lower among patients with a disease duration of between 2 and 10 years than among patients with a disease duration of more than 10 years. In addition, the proportional distribution of different cost categories to total costs increases with with increasing disease duration.

['Public health status and perspectives' 1997. III. Health inequalities in the Netherlands]. / 'Volksgezondheid toekomst verkenning' 1997. III. Gezondheidsverschillen in Nederland.

The theme report 'Health inequalities' of the Dutch 'Public health status and forecasts' 1997 indicates that there are substantial health inequalities between population groups in the Netherlands, most notably with respect to socioeconomic status, but also in respect to other sociodemographic characteristics. It is expected that the numbers of people in several of these disadvantaged groups will increase. Improving the health status of disadvantaged groups can therefore theoretically produce great health gains.

The incidence of suspected myocardial infarction in Dutch general practice in the period 1978-1994.

AIM: To evaluate how the incidence of suspected myocardial infarction has developed from 1978 to 1994 and to study the incidence of confirmed acute myocardial infarction in Dutch general practices during the period 1991-1994. METHODS: In three periods (1978, 1983-1985 and 1991-1994) the incidence of suspected myocardial infarction has been registered by the 'Dutch Sentinel Practice Network'. This is a registration system that obtains data from general practitioners covering about 150,000 persons. During the period 1991-1994 the incidence of confirmed myocardial infarction was also registered. RESULTS: For men, the incidence rate of suspected myocardial infarction decreased by 28% from 4.7 per 1000 in 1978 to 3.4 per 1000 in the period 1991-1994. For women, the incidence fell by 23% from 2.6 per 1000 in 1978 to 2.0 per 1000 in the period 1983-1985 and stabilized thereafter. The most pronounced decrease in the incidence of suspected myocardial infarction during the period 1978-1994 occurred in both men and women aged 45-64. In the period 1991-1994, the standardized incidence rate of confirmed myocardial infarction is 1.7 per 1000 for men and 0.9 per 1000 for women. CONCLUSIONS: These data suggest that the incidence of suspected myocardial infarction has declined substantially between 1978 and 1994 both for men and for women; this decline is most pronounced in the age group 45-64.

Cardiovascular risk factors in relation to educational level in 36 000 men and women in The Netherlands.

The study objective was to describe the associations between socioeconomic status and (concurrence of) cardiovascular risk factors. The Netherlands Monitoring Project on Cardiovascular Risk Factors is a screening project that was carried out from 1987-1991 in three cities. Cross-sectional data were obtained on educational level and on the prevalence of smoking, alcohol intake, physical inactivity, obesity, hypertension, hypercholesterolaemia and low HDL-cholesterol. A total of 36 000 men and women, aged 20-59 years participated. For all risk factors, except alcohol intake, a significant inverse association was found with educational level. Concurrence of risk factors was more prevalent in lower educated groups than in higher educated groups, but not more than can be expected under the condition of independence of the risk factors (no clustering). In conclusion, in the lower educated groups the prevalence of individual risk factors and of concurrence of risk factors was higher than in the higher educated groups. Concurrence of risk factors can have a synergistic effect on the risk for cardiovascular disease. Therefore socioeconomic differences in risk factors may explain a greater part of the socioeconomic differences in cardiovascular morbidity and mortality than is generally assumed.

Is the incidence of diabetes increasing in all age-groups in The Netherlands? Results of the second study in the Dutch Sentinel Practice Network.

OBJECTIVE: To assess possible changes in the incidence of diabetes in all age-groups in The Netherlands during a 10-year period (1980-1983/1990-1992). RESEARCH DESIGN AND METHODS: Since 1970, a network of sentinel stations (the Dutch Sentinel Practice Network) consisting of approximately 1% of the Dutch population has been in operation to gain insight into the morbidity patterns of the Dutch population as recorded by general practitioners. One of the items recorded from 1990 to 1992 was the incidence of diabetes. The first study with a similar design that registered the incidence of diabetes was conducted from 1980 to 1983. RESULTS: The overall incidence of diabetes increased significantly by 12.1% in the period between the two studies. This overall increase can largely be attributed to a statistically significant increase in the age-group 45-64 years (30.5%). Although not statistically significant, the 36% increase of diabetes in the age-group 0-19 years is in accordance with the increase of type I diabetes based on the first and second nationwide retrospective studies covering the total Dutch population. CONCLUSIONS: There is a marked increase in the incidence of diabetes in the age-group 45-64 years. This selective increase is probably not due to a real rise caused by changes in exposure to risk factors but to an earlier recognition of symptoms and signs of diabetes followed by blood glucose measurements and/or to more intensive case finding in general practice.

Forecasting the number of diabetic patients in The Netherlands in 2005.

OBJECTIVES: There is evidence from past decades that the number of diabetic patients has increased independently of changes in demography. A static model that takes into account only demographic changes is therefore unable to forecast the expected number of diabetic patients correctly. METHODS: We developed a dynamic model in which actual incidence, prevalence, and life expectancy data are used and alternative assumptions about future trends in these parameters can be incorporated. RESULTS: This dynamic model forecasts higher numbers of diabetic patients than the less sophisticated static model. According to the dynamic model, a 46% increase in the number of diabetic patients in The Netherlands can be expected, from 244,000 in 1990 to 355,000 in 2005 (about 2.5% annually). The static model forecasts a 22% increase. CONCLUSIONS: Diabetes mellitus will become a more serious public health problem than can be expected from demographic changes only. In planning future health care, monitoring of trends in incidence, prevalence, remission, and mortality or life expectancy is a necessary prerequisite.

Selecting a health indicator for comparative health surveys among different social categories using employment as example.

In the last decade a number of subjective health indicators have been developed and validated. In view of the investment involved in developing a new one, a researcher designing a health survey will preferably choose one of the existing indicators. To facilitate such a choice, a set of criteria is developed. Six existing indicators are valued according to the stipulated criteria. Unemployment is taken as the example because there is a demand for comparative health surveys between unemployed and employed in order to validate findings in the unemployment literature. The comparison of the health of unemployed and employed is used as an example on the basis of which more general statements can be made about the comparison of the health of people in other polar social roles like divorced versus married, immigrants versus residents, that involve a transition from one social role to another.

Gonorrhoea and foreign immigrants at Rotterdam University Hospital.

It is estimated, contrary to public opinion and a quick glance at the waiting room of the sexually transmitted diseases (STD) clinic in Rotterdam, that the incidence of gonorrhoea among foreign immigrants is only a little greater than among the Dutch population. The analysis corroborates the common sense idea that the higher incidence of gonorrhoea among foreign immigrants stems largely from their difficulty in finding sexual partners. To solve this problem is a matter of national policy. It is within the scope of the STD clinics and related organizations to start small-scale experiments to improve the difficult medical situation of the foreign immigrants by lowering the linguistic and cultural barriers between the medical staff and their foreign patients. Research on the sexual habits of the patients is of limited value, and a redirection of our efforts seems necessary to tackle this problem.