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Résumé Objectif Évaluer les coûts d’utilisation des services de soins de santé des patients atteints de polyarthrite rhumatoïde (PR) en France et estimer la proportion de ces coûts imputables à la PR. Méthode L’EGB (« échantillon généraliste des bénéficiaires ») est un échantillon aléatoire 1/97 de la principale base de données nationale couvrant la population française. Une cohorte de patients atteints de polyarthrite rhumatoïde a été constituée avec tous les adultes qui bénéficient d’une prise en charge complète pour leur polyarthrite rhumatoïde (ICD-10 M05-06) au 1 er janvier 2009. Un groupe de témoin apparié par âge et sexe a été défini. Les dépenses de santé ont été évaluées du point de vue du payeur pour l’année 2010. Résultats La dépense de santé annuelle totale remboursée par habitant était de 6404 € en 2010, montant environ deux fois plus élevé que celui du groupe de témoin, 3095 € ( p < 0,0001). Ce surcoût est principalement dû aux soins en ambulatoire (+ 2407 € ; 72,7 %), aux médicaments (+ 1686 € ; 50,0 %) et aux soins hospitaliers (+ 903 € ; 27,3 %). Les patients traités par des biothérapies ont généré une dépense annuelle ajustée par âge par habitant trois fois plus élevée que celle des non-traités (15 757 € versus 4640 €). Conclusion Seule la moitié des dépenses médicales des patients atteints de polyarthrite rhumatoïde est imputable à leur maladie et la biothérapie est devenue un facteur important du coût. [ABSTRACT FROM AUTHOR]

Objective: To estimate healthcare service utilisation costs of patients with rheumatoid arthritis in France and to estimate the fraction of these costs attributable to RA.Method: The "Échantillon généraliste des bénéficiaires" (EGB) is a 1/97 random sample of the main national claims database covering the French population. A cohort of patients with rheumatoid arthritis was constituted of all adults benefiting from full coverage for rheumatoid arthritis (ICD-10 M05-06) on 1st january 2009. A control group matched for age and gender was identified. Health expenditures were assessed from the payer's perspective for the year 2010.Results: The annual per capita reimbursed total health expenditure was €6,404 in 2010, an amount around two times higher than in the control group €3,095 (P<0.0001). The main contributors to this extra cost were outpatient care (+€2,407; 72.7%), including medication (+€1,686; 50.0%), and inpatient care (+€903; 27.3%). Patients treated by biological agents generated an age-adjusted per capita annual expenditure about three times higher than untreated patients (€15,757 versus €4,640).Conclusion: Only half of medical expenditure by patients with rheumatoid arthritis is attributable to their disease and use of biological agents has become a major driver of cost. [ABSTRACT FROM AUTHOR]

• La prévalence de la SpA grave a été estimée à 0,18 %, ce qui correspond à 87 979 cas en France en 2012. • L'hypertension sévère, la fibrillation atriale et la dépression étaient surreprésentées chez les patients atteints de SpA grave. • La dépense moyenne per capita de soins de santé était 3,6 fois plus élevée chez les patients atteints de SpA grave que chez les témoins. Estimer le nombre de patients présentant une spondyolarthrite (SpA) grave en France, décrire leurs comorbidités et consigner et valoriser leur consommation de soins. Les données ont été extraites de l'Échantillon généraliste des bénéficiaires qui couvre 1/97e des personnes couvertes par l'assurance maladie en France. Tous les patients bénéficiant d'une prise en charge à 100 % (ALD, affection de longue durée) au titre d'une SpA grave en 2012 (y compris ceux présentant des dommages structuraux et/ou des poussées fréquentes) ont été identifiés et un groupe témoin apparié par fréquence selon l'âge et le sexe a été sélectionné. Les comorbidités sévères ont été documentées selon les catégories de l'ALD. La consommation de soins a été consignée et valorisée du point de vue de l'organisme payeur. Les taux de comorbidités et les coûts ont été comparés entre les patients atteints de SpA et les témoins par une méthode de test non paramétrique. Au total, 827 patients admis en ALD au titre d'une SpA grave ont été identifiés (groupe témoin n = 2 481), soit un taux de prévalence de la SpA en ALD de 0,18 % [0,17–0,19] dans la population générale. Les comorbidités sévères plus fréquentes chez les patients atteints de SpA que chez les témoins comprenaient : maladies inflammatoires chroniques de l'intestin (Odds Ratio 15,0 [2,2–6,6–36], hypertension (2,5 [1,6–3,9]), fibrillation auriculaire (4,3 [1,6,9]) et trouble dépressif majeur (2,1 [1,3,6]). La dépense de santé directe moyenne annuelle per capita était 3,6 [1–3,3,4] fois plus élevée chez les patients atteints de SpA (6122 € [5838–6406]) que chez les témoins (1682 € [1566–1798]). L'extrapolation de ces chiffres à l'ensemble des patients en France aboutit à un coût total de soins attribuables aux SpA graves de 391 millions € [355–426], dont 53,8 % pour les médicaments. Le fardeau considérable des spondyloarthrites graves en France résulte de la forte prévalence de cette maladie, des coûts directs élevés et des comorbidités associées. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the number of patients with severe spondyloarthritis (SpA) in France, describe their comorbidities and document and value their healthcare resource consumption.Methods: Data were retrieved from an insurance claims database covering a 1/97 random sample of the French population. All patients benefiting from full insurance coverage ("ALD") for severe SpA in 2012 (including cases with structural damage and/or frequent flares) were identified, together with a control group frequency-matched by age and gender. Severe comorbidities were documented through ALD categories. Healthcare resource consumption was documented and valued from the payer's perspective. Rates of comorbidities and costs were compared in SpA patients versus controls using non-parametric testing.Results: Overall, 827 patients with ALD status for severe SpA were identified (control group: n=2.481), corresponding to a prevalence rate of 0.18% [0.17-0.19] for SpA with ALD in the general population. Severe comorbidities more frequent in patients with SpA than in controls included inflammatory bowel disorders (odds ratio: 15.0 [6.2-36.2]), hypertension (2.5 [1.6-3.9]), atrial fibrillation (4.3 [1.9-9.6]) and major depressive disorder (2.1 [1.3-3.6]). Mean per capita annual direct healthcare expenditure was 3.6 [3.2-4.1]-fold higher in SpA patients (€6,122 [€5,838-€6,406]) than in controls (€1,682 [€1,566-€1,798]). Extrapolating to all patients in France, total healthcare cost attributable to severe SpA patients was €391 [€355-€426] million, with medication accounting for 53.8% of this cost.Conclusions: The burden of severe SpA in France is substantial, due to the high prevalence, high direct costs and associated comorbidities. [ABSTRACT FROM AUTHOR]

Misinterpretation of patient beliefs may complicate shared decision-making in rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). The objective of this study was to develop a questionnaire to assess patients’ beliefs about their disease and its treatment, and to identify patient characteristics associated with these beliefs. All beliefs reported by > 5% of 50 patients in a previous study were reformulated with a partnering patient organization into statements with which participants could rate their agreement on a scale of 0-10 (totally disagree to totally agree). The resulting Questionnaire for Arthritis Dialogue (QuAD) was made available to patients with RA or axSpA. A score ≥ 7 was considered a strongly held belief. Associations between patient characteristics and individual lifestyle beliefs were assessed using multiple logistic regression. The 21-item QuAD was completed by 672 patients (432 RA, 240 axSpA; mean [±SD] age 54.2 [± 14.2]; 63.7% female). The most widely held beliefs were related to uncertainty about progression (n = 354, 54.0%), heredity (n = 309, 47.8%), and flare triggers (n = 283, 42.7%). The unwarranted belief that physical activity is deleterious to disease activity was associated with markers of psychological distress and lower educational levels. The beliefs of patients with RA or axSpA about their disease are wide-ranging. Since these may be unwarranted and may lead to inappropriate behaviors, physicians should discuss these beliefs with their patients. The QuAD may facilitate this dialogue, and may also be useful in population studies to standardize the assessment and evolution of beliefs over time. People with long-term inflammatory conditions such as rheumatoid arthritis (RA; inflammation of the joints) and axial spondyloarthritis (axSpA; inflammation of the spine) may hold a number of beliefs about their disease, including some that are not supported by current scientific evidence (e.g., “I think that my disease was triggered by a vaccination”). Some beliefs, especially those relating to the role of lifestyle factors (such as exercise, diet, smoking, and drinking alcohol), may encourage people living with severe diseases to change their behavior in a way that has an effect on their disease. Within this project, we developed a questionnaire to identify the most common beliefs held by people living with RA or axSpA, which is called the “Questionnaire for Arthritis Dialogue (QuAD).” We also examined whether certain characteristics (or traits) of people living with RA or axSpA are linked to beliefs not currently supported by scientific evidence. A total of 672 people living with RA or axSpA in France were asked to complete the questionnaire (QuAD). The questionnaire included 21 opinion statements that they scored from 0 (totally disagree) to 10 (totally agree). A score of more than 7 was interpreted to mean that the person significantly agreed with the opinion. Based on the responses to specific opinion statements in the questionnaire, we were able to identify possible links between beliefs that are not supported by scientific evidence (e.g., “I think that flare-ups of my disease are triggered by physical effort”), and characteristics of people living with severe diseases. Our findings suggested that beliefs about lifestyle and inflammatory diseases varied from person to person, were sometimes inconsistent (the most widely held beliefs were sometimes contradictory), and were often not supported by scientific evidence. The belief that physical activity had negative effects on the disease was linked to poor education and psychological issues (such as anxiety and helplessness). People living with axSpA were more likely to believe their disease was a result of their genetic make-up, whereas those with RA more often believed their disease was caused by emotional issues. People living with axSpA were also more likely to believe that physical activity could be beneficial for their disease, and less likely to believe that their disease was caused by smoking. Our results suggest that doctors need to discuss with their patients how they might believe lifestyle is associated with their disease. This will help to dispel any unnecessary concerns, and to encourage their patients to take up healthy lifestyles and habits that are beneficial for their disease management. It may also be beneficial for health care providers to discuss the beliefs identified in this study during educational programs about inflammatory diseases, for the benefit of people living with RA or axSpA. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the impact of rheumatoid arthritis (RA) on career, productivity, and employability.Methods: A retrospective cross-sectional survey was conducted in 2012-2013 in France among patients with RA who were younger than 60 years of age and employed or unemployed. Patients were either recruited during a rheumatologist visit or among members of a nationwide patient-support organization (ANDAR). They completed a questionnaire on the functional impact of RA evaluated by the Health Assessment Questionnaire (HAQ) and on the impact of their disease on work ability.Results: Of 488 surveyed patients, 364 (74.6%) were actively employed, 31 (6.4%) were job seekers, and 93 (19.1%) had left the workforce. In the employed group, mean age was 48.9 years; 82.1% of patients were women; mean RA duration was 11.6 years; and the HAQ score correlated strongly with various markers for decreased productivity including sick leaves, temporary or permanent work discontinuation, and having unwillingly downgraded from a full-time to a part-time work schedule or changed to a different job. Among job seekers, 54% had lost their previous job because of their RA.Conclusion: RA is associated with various forms of work disability, which are directly related to the severity of disease-related functional impairments. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Étudier les conséquences de la polyarthrite rhumatoïde (PR) sur la trajectoire professionnelle des patients, l’employabilité et la productivité. Méthode Une étude transversale et rétrospective a été conduite en 2012–2013 en France auprès d’un échantillon de patients atteints de polyarthrite rhumatoïde et âgés de moins de 60 ans en activité ou non, soit recrutés lors d’une consultation de rhumatologie, soit auprès des adhérents d’une Association nationale de malades (ANDAR). Les questions portaient sur le retentissement fonctionnel de la PR mesurée par le score Health Assessment Questionnaire et son impact sur l’activité professionnelle. Résultats Quatre cent quatre-vingt-huit patients ont été interrogés. Parmi eux, 364 patients (74,6 %) étaient en activité (actifs employés), 31 (6,4 %) en recherche d’emploi et 93 (19,1 %) étaient sortis du marché du travail. Les actifs employés avaient un âge moyen de 48,9 ans et 82,1 % étaient des femmes. Dans ce groupe, la durée moyenne de la maladie était de 11,6 ans et le Health Assessment Questionnaire était fortement corrélé aux différentes formes de pertes de productivité : arrêts de travail, cessation temporaire ou définitive d’activité, passage contraint au temps partiel ou reclassement professionnel. Parmi les patients en recherche d’emploi, la perte d’emploi était liée à la PR dans plus de la moitié des cas (54 %). Conclusion Les différentes formes d’incapacité professionnelle associées à la PR sont directement liées à l’importance du retentissement fonctionnel. [ABSTRACT FROM AUTHOR]

The original version of this article was revised due to a retrospective Open Access order. [ABSTRACT FROM AUTHOR]