POS1049 ECONOMIC BURDEN AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS: A SINGLE CENTRE CROSS-SECTIONAL STUDY
Authors: M. Gopalakrishnan, K. Joshi, A. Kumar P H, P. Thirunavukkarasu, S. Khichar, S. Srinivasan
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The economic burden of Rheumatoid arthritis (RA) relates to the cost of the treatment which is significant for the individual and also for the health care and social care system. Assessing the economic impact of RA on patients is an important prerequisite for allocating resources and managing the disease from the health system perspective. <h3>Objectives:</h3> The study aimed to determine the economic burden of the illness and assess the quality of life in patients with RA in our setting. <h3>Methods:</h3> After Institutional Ethics Committee approval, a cross-sectional study was conducted at the rheumatology clinic at All India Institute of Medical Sciences (AIIMS), Jodhpur, India. The data collection tool used to estimate the Cost of Illness (COI) of patients with RA included a semi-structured, pretested questionnaire and individual patient interviews after receiving the consent. Disease activity was calculated using the Disease Activity Score (DAS28-CRP). The quality of life of the patients was analyzed based on the EQ-5D-5L questionnaire. The EQ-5D is a descriptive and visual analog scale (VAS) framework that measures health in 5 dimensions, such as mobility, self-care, usual activities, pain/ discomfort, and anxiety/ depression. <h3>Results:</h3> A total of 225 patients were enrolled. The mean age group was 47.8 ± 12.7 years and about 79.6% were females. Occupational status - 85 (82.2%) were unemployed, followed by skilled workers (8.9%), semiskilled workers (6.7%), and semi-professionals (2.2%). The majority (92.9%) of patients were married. About 28.9% of patients belonged to the upper middle class, 24.9% to the middle class, 20.4% to the upper class, 17.4% to the lower middle class, and 8.4% to the lower class based on their per capita income (Table 1). A total of 139 patients had DAS28-CRP calculated, of whom, 30 (13.3%) were in remission, 8 (3.6%) had low disease activity, 66 (29.3%) had moderate disease activity and 35 (15.6%) had high disease activity. The annual median (IQR) for the total direct cost of the RA patients was Indian Rupee (INR) 18005 (12907-25393)/ EUR 198.7. The annual median indirect cost (IQR) for the loss of productivity was INR 2800 (1500-4000)/ EUR 30.9. The annual median (IQR) for total cost (direct cost + indirect cost) was INR 19076 (13602-27776)/ EUR 210.5 (Table 2). Indirect costs were mainly calculated for loss of productivity for patients and their caregivers. A total of 118 (52.4%) patients were using health insurance. Among those insured, 44% were under an insurance scheme under the Government of India, 4.9% were government employees, 3.1% were using other insurance schemes and 1.8% of patients were using private insurance. The median (IQR) EQ- 5D utility score was 0.56 (0.17- 0.74). <h3>Conclusion:</h3> The total cost of disease as well as indirect cost was lower as compared to other studies, the probable reason for which could be the subsidized treatment at AIIMS, a tertiary care teaching institute under the Government of India. More than 60% of the patients experienced slight and moderate problems in each domain of the EQ-5D 5L tool. The median EQ-5D utility score was comparatively lower in comparison to that of other countries [1]. Hence it is vital to diagnose and control the disease at an early stage to control the economic burden on the patient and to plan therapeutic and rehabilitation interventions considering various parameters of quality of life. This study will help advance our knowledge of the costs incurred by patients with RA and is expected to serve as a reference for future health-related policy development. <h3>REFERENCES:</h3> [1] Haridoss M, Bagepally BS, Natarajan M. Health-related quality of life in rheumatoid arthritis: Systematic review and meta-analysis of EuroQoL (EQ-5D) utility scores from Asia. Int J Rheum Dis. 2021 Mar;24(3):314-326. doi: 10.1111/1756-185X.14066. Epub 2021 Jan 23. PMID: 33486900. <h3>Acknowledgements:</h3> Prof. Pankaj Bhardwaj, Academic Head School of Public Health and Prof. Mahendra Kumar Garg, Head of Department of Internal Medicine. <h3>Disclosure of Interests:</h3> <b>None declared.</b>