THU0633 ECONOMIC IMPACT OF HEALTHCARE RESOURCE UTILIZATION AND WORK DISABILITY IN PORTUGUESE PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS FROM THE ASSESSMENT OF RESULTS IN ANKYLOSING SPONDYLITIS(AREA) STUDY
Authors: Filipe Araújo, Cláudia Duarte, Jorge Brandão, Rui Cernadas, Elsa Mateus, Luís Cunha Miranda, José Canas Da Silva, José Gomes Da Silva, Pedro Simões Coelho
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Ankylosing spondylitis (AS) has a significant burden upon the individual, family and society. Understanding the economic impact of AS is crucial to substantiate policies that promote early referral, diagnosis and treatment. <h3>Objectives</h3> To assess the economic impact of AS in Portugal concerning healthcare utilization and work disability. <h3>Methods</h3> The Assessment of REsults in Ankylosing spondylitis (arEA) study was developed by the NOVA-Information Management School (Lisbon) in collaboration with the Portuguese Society of Rheumatology, the Portuguese Association of Family Physicians, the National Association of Primary Care Units, the National Association of AS Patients and the Portuguese League Against Rheumatic Diseases. The arEA aimed at assessing reasons for delayed diagnosis of AS, as well as disease impact in patients' lives, global health and work. A comprehensive online survey was developed and sent to AS patients. Data on demographics, lifestyle habits, daily life activities, working habits, disease indexes and healthcare utilization was retrieved. Costs of the disease for patients resulting from the use of health systems was obtained thorough patient's declaration, the cost for the national health service (SNS) was obtained combining primary data and secondary data related with the average costs of service use. Finally, the impact over the economy was also estimated through the participation of patients in labor market and using as mediator variables the absenteeism and presenteeism. A set of generalized linear models were used to identify the factors with significant effect over health status, SNS costs and impact over economy. <h3>Results</h3> 354 patients responded the survey, 42.1% female, more frequently from the 35-44 year-old age group. In the previous 12 months, 76% reported using the National Healthcare System (SNS) for AS-related reasons (85% outpatient visits; 74% diagnostic exams; 48% ER visits; 8% inpatient admissions). During that period, estimated SNS expenditure with AS patients reached €47 million, excluding costs with medication (ongoing analysis), distributed as: outpatient visits €25 million, diagnostic exams €7 million, ER visits €3 million and inpatient admissions €12 million. Adding to this, patients spent on average €84 million out of their own pocket on AS-related expenses (€1.786 per patient: outpatient visits €245, diagnostic exams €151, ER visits €48, inpatient admissions €415, medication €593, travelling expenses €334). Regarding work disability, working AS patients reported an average of 12 days on leave of absence and 25 days on sick leave per year, with an estimated cost of €28 and €57 million, respectively. Presenteeism led to a loss of 73 working days with a cost of €165 million. Taking also into account patients with prolonged leaves of absence (€72 million), permanent leaves (€18 million), unemployed (€50 million) and family medical leaves (€47 million), the overall costs with work disability in AS reached €437 million in one year. <h3>Conclusion</h3> AS-related work disability and healthcare resource utilization have an enormous economic impact in Portugal. Investment in strategies that encourage early referral, diagnosis and treatment is fundamental to mitigate such burden. <h3>Disclosure of Interests</h3> None declared