Direct healthcare resource utilisation, health-related quality of life, and work productivity in patients with moderate rheumatoid arthritis: an observational study

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Abstract

Background

The aim was to describe the population of patients with moderate rheumatoid arthritis (RA) in the United Kingdom and the burden of disease from the perspectives of the patient, caregiver, and health service.

Methods

In this descriptive study, retrospective patient-level data were extracted from hospital medical records to assess healthcare resource utilisation and validated outcome measures were administered via questionnaire to patients with moderate RA (Disease Activity Score [DAS28] between 3.2 and 5.1) from eight secondary care centres, and their caregivers. Patient-reported outcome instruments were scored according to licensed manuals.

Results

Outcome measures were completed by 102 patients and 38 caregivers. The mean EuroQoL-5 dimension-5 level crosswalk index value for patients was 0.62 (SD 0.24) compared to an England population norm of 0.82. Mean pain VAS score was 37.7 (SD 24.0) and mean Health Assessment Questionnaire Disability Index was 1.1 (SD 0.8). In employed patients who completed the Work Productivity and Activity Impairment questionnaire ( n = 26), a mean 29% (SD 26%) reduction in work productivity was recorded. Patients experienced significant fatigue as a result of their RA (median Functional Assessment of Chronic Illness Therapy fatigue score 17.2 of a possible 52, interquartile range [IQR] 11.0–28.8). Over 50% of caregivers reported providing > 7 h of support care per week to the patient with RA, and 16 and 11% took paid/unpaid leave or reduced working hours, respectively. Mean Caregiver Reaction Assessment subscale scores were 1.9 (SD 0.9) for finance, 1.7 (SD 0.8) for health, 2.3 (SD 1.0) for schedule disruption, and 1.9 (SD 0.8) for family support. Patients had a mean 5.5 (SD 4.1) outpatient attendances and a median 9.0 (IQR 2.0–20.0) diagnostic and monitoring tests in the 12 months prior to enrolment.

Conclusions

This study shows that moderate RA has a considerable impact on healthcare resources and on patients’ and caregivers’ lives. There is scope to improve the management of patients with moderate RA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04110-1.

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Most cited references 40

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Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

M. Herdman, C. Gudex, S Lloyd … (2011)

Purpose This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. Methods EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Results Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. Conclusions A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.

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Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).

Gillian A Hawker, Samra Mian, Tetyana Kendzerska … (2011)

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Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force

Josef Smolen, Ferdinand C Breedveld, Gerd Burmester … (2015)

Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10). Conclusions The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.

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Author and article information

Contributors

Sophee Blanthorn-Hazell:

ORCID: http://orcid.org/0000-0003-4556-2288

sophee.blanthornhazell@abbvie.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 13 March 2021

Publication date PMC-release: 13 March 2021

Publication date Collection: 2021

Volume: 22

Electronic Location Identifier: 277

Affiliations

[1 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Centre for Rheumatic Diseases, , King’s College London, ; London, UK

[2 ]GRID grid.439674.b, ISNI 0000 0000 9830 7596, Research and Development Department, , Royal Wolverhampton NHS Trust, ; Wolverhampton, UK

[3 ]GRID grid.440202.0, ISNI 0000 0001 0575 1944, West Suffolk NHS Foundation Trust, ; Bury Saint Edmunds, UK

[4 ]GRID grid.462482.e, ISNI 0000 0004 0417 0074, Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Research Centre, , Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, ; Manchester, UK

[5 ]GRID grid.413818.7, ISNI 0000 0004 0426 1312, NIHR Leeds Biomedical Research Centre, , Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, ; Leeds, UK

[6 ]GRID grid.31410.37, ISNI 0000 0000 9422 8284, Sheffield Teaching Hospitals, ; Sheffield, UK

[7 ]OPEN VIE, Marlow, UK

[8 ]AbbVie Limited, Maidenhead, UK

[9 ]GRID grid.416642.3, ISNI 0000 0004 0417 0779, Rheumatology Department, , Salisbury District Hospital, ; Salisbury, UK

Author information

Sophee Blanthorn-Hazell http://orcid.org/0000-0003-4556-2288

Article

Publisher ID: 4110

DOI: 10.1186/s12891-021-04110-1

PMC ID: 7956119

PubMed ID: 33714274

SO-VID: 02e6c993-a4a0-4766-a713-deac071eb1e9

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 24 July 2020

Date accepted : 23 February 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100006483, AbbVie;

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: rheumatoid arthritis,quality of life,eq-5d,burden,moderate,das28,patient-reported outcome,resource utilisation,caregiver

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: rheumatoid arthritis, quality of life, eq-5d, burden, moderate, das28, patient-reported outcome, resource utilisation, caregiver

Direct healthcare resource utilisation, health-related quality of life, and work productivity in patients with moderate rheumatoid arthritis: an observational study

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Most cited references 40

Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force

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