12Cost of rheumatic disorders in the Netherlands
Introduction
Rheumatism or a rheumatic disorder is a non-specific term used to describe any painful disorder affecting the musculoskeletal system including joints, muscles, connective tissues and soft tissues around the joints and bones. It is also used to describe rheumatic fever affecting heart valves. However, the medical profession uses specific terms to describe rheumatic disorders such as rheumatoid arthritis, ankylosing spondylitis, gout and systemic lupus erythematosus, of which there are more than 100 various clinical types. Despite differences in clinical features, they have in common that they are responsible for a considerable amount of health-care use and disability [1].
Next to the disease burden, rheumatic disorders represent a substantial economic burden on society. This economic burden can be estimated in a cost-of-illness study by identifying and measuring all costs of a disease. Cost-of-illness studies do not provide information on how rheumatic disorders should be treated, but they can be used for description next to other estimates based on incidence or mortality, for comparisons in time and between countries and projection of future health costs [2]. There are several published cost-of-illness estimates on rheumatic disorders *[3], *[4], *[5], *[6], *[7]. However, most cost-of-illness studies on rheumatic disorders are restricted to a specific condition, as, for example, rheumatoid arthritis *[3], *[7] and ankylosing spondylitis [5]. Moreover, usually, cost-of-illness estimates include the direct and indirect costs of a disease. However, it is argued that also costs associated with patient health losses that do not directly translate into health-service use or productivity losses should be incorporated [7]. These so-called intangible costs are costs of the inconvenience and difficulties for the patient, such as pain, anxiety and discomfort. To estimate the intangible costs the use of the willingness-to-pay (WTP) method [8], [9] is proposed.
The aim of this study was to estimate the societal costs of rheumatic disorders in the Netherlands, including the intangible costs.
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Material and methods
To assess the costs of rheumatic disorders in the Netherlands from the societal perspective we estimated the direct costs, indirect costs and intangible costs. Direct costs are all health-care costs that are directly related to the treatment of the disease, as, for example, hospital days, consultations with doctors and medication. Indirect costs arise as a secondary result of the disease, such as production losses in paid and unpaid work. Intangible costs are the monetary value of the
Direct costs
Total additional costs of primary care due to rheumatic disorders in the Netherlands are assessed to be €909 million per year. In Table 1, these costs are broken down to caregiver and major disease category (inflammatory rheumatic diseases, soft-tissue rheumatic diseases and osteoarthritis). More than 60% of the costs of primary care can be attributed to care provided by physiotherapists and occupational therapists, followed by 25% of the costs as a result of home care.
Total costs of surgery
Discussion
Total societal costs of rheumatic disorders in the Netherlands amount to €4.7 million a year, that is, €2665 per person with rheumatic disorders. However, this estimate is highly dependent on the choice of the method to calculate indirect costs and to a lesser extent the intangible costs.
This cost-of-illness study is based primarily on data from the NMMS-2010 [10], which are self-reported data on health-care use, work absence and occupational disability of a representative group of people aged
Summary
Total societal costs of rheumatic disorders in the Netherlands amount to €4.7 million a year, that is, €2665 per person with rheumatic disorders. Compared to cost estimates of rheumatoid arthritis and ankylosing spondylitis, our estimates for rheumatic disorders in general are at the lower end, which can be explained by the fact that rheumatoid arthritis and ankylosing spondylitis are chronic forms of inflammatory rheumatic diseases associated with prolonged treatments and costs while costs of
Conflict of interest
All authors declare to have no conflict of interest.
Acknowledgements
Funding/Support: This study was funded by the Dutch Arthritis Association (Reumafonds), the Netherlands. The Dutch Arthritis Association did not participate in the analysis and interpretation of the data, or in the preparation, review or approval of the manuscript.
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