A betegségprogresszió hatása az egészségi állapotra, életminőségre és költségekre rheumatoid arthritisben Magyarországon. [Impact of disease progression on health status, quality of life and costs in rheumatoid arthritis in Hungary]

Rheumatoid arthritis (RA) is a chronic, progressive polyarthritis leading to substantial disability. Standardised data on consequences of discase progression are needed for clinical assessments and also for cost-effectiveness models. Aim: To analyse the impact of disease progression on health status, disease specific quality of life and costs in Hungary. Methods: A cross-sectional survey was performed between April and August, 2004, involving consecutive RA patients of 6 hospital based rheumatology outpatient centres. Self-completed questionnaires were used to assess functional (HAQ) and health status (EQ-5D), quality of life (RAQoL). Disease activity (DAS) and costs were also surveyed, statistical analysis was performed. Results: 255 patients were involved [mean age 55.5 ± 12.3 years; disease duration 9.0 ± 9.3 years; HAQ 1.38 ± 0.76; EQ-5D 0.46 ± 0.33; RAQoL 16.2 ± 8.1; DAS 5.09 ± 1.42; costs 1,043,163 (± 844,750) HUF/patient/year, conversion 1 Euro = 250 HUF]. Correlation was significant between the parameters (p<0.01): EQ-5D index = 1.014-0.25 × HAQ-0.041 × DAS; HAQ = 0.314 + 0.065 × RAQoL. Analysis by disease severity levels (HAQ groups 0.5 difference) revealed that health status worsens (mean EQ-5D: 0.784; 0.576; 0.504; 0.3671 0.211; 0.022) and costs increase (mean 628,280; 888,187; 953,759; 1,291,218; 1,346,112; 1,371,674 HUF/patient/ year) with disease progression. Minimally important worsening of functional ability (0.25 HAQ increase) corresponds to -0.0705 EQ-5D and + 1.884 RAQoL change. Lower health status difference (EQ-5D -0.05725) was calculated in patients with lower disease activity (DAS < 5.1). Conclusions: Correlation between disease progression, health status, quality of life and costs does not differ significantly from international results. The amount of costs is much lower in all disease severity levels than in developed European countries. Our study serves baseline data for health economic analysis in RA in Hungary.