Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 2004 Apr; 63(4): 395–401.
PMCID: PMC1754963

The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study


Objective: To compare the economic burden to society incurred by patients with RA, OA, or high blood pressure (HBP) in Ontario, Canada.

Methods: Consecutive subjects recruited by 52 rheumatologists (RA) and 76 family physicians (OA and HBP) were interviewed at baseline and 3 months. Information was collected on demographics, health status, and any comorbidities. A detailed, open ended resource utilisation questionnaire inquired about the use of medical and non-medical resources and patient and care giver losses of time and related expenses. Annual costs were derived as recommended by national costing guidelines and converted to American dollars (year 2000). Statistical comparisons were made using ordinary least squares regression on raw and log transformed costs, and generalised linear modelling with adjustment for age, sex, educational attainment, and presence of comorbidities.

Results: Baseline and 3 month interviews were completed by 253/292 (86.6%) patients with RA and 473/585 (80.9%) patients with OA and/or HBP. Baseline and total annual disease costs for RA (n = 253), OA and HBP (n = 191), OA (n = 140), and HBP (n = 142), respectively, were $9300, $4900, $5700, and US$3900. Indirect costs related to RA were up to five times higher than indirect costs incurred by patients with OA or HBP, or both. The presence of comorbidities was associated with disease costs for all diagnoses, cancelling out potential effects of age or sex.

Conclusion: The economic burden incurred by RA significantly exceeds that related to OA and HBP, while differences between patients with a diagnosis of OA without HBP or a diagnosis of HBP alone were non-significant, largely owing to the influence of comorbidities.

Full Text

The Full Text of this article is available as a PDF (281K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bloom BS, Bruno DJ, Maman DY, Jayadevappa R. Usefulness of US cost-of-illness studies in healthcare decision making. Pharmacoeconomics. 2001;19(2):207–213. [PubMed]
  • Koopmanschap MA. Cost-of-illness studies. Useful for health policy? Pharmacoeconomics. 1998 Aug;14(2):143–148. [PubMed]
  • Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998 May;41(5):778–799. [PubMed]
  • Stewart AL, Hays RD, Ware JE., Jr The MOS short-form general health survey. Reliability and validity in a patient population. Med Care. 1988 Jul;26(7):724–735. [PubMed]
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. [PubMed]
  • Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982 Sep-Oct;9(5):789–793. [PubMed]
  • Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ. 2001 Jul;20(4):461–494. [PubMed]
  • Rutten-van Mölken MP, van Doorslaer EK, van Vliet RC. Statistical analysis of cost outcomes in a randomized controlled clinical trial. Health Econ. 1994 Sep-Oct;3(5):333–345. [PubMed]
  • Chang BH, Pocock S. Analyzing data with clumping at zero. An example demonstration. J Clin Epidemiol. 2000 Oct;53(10):1036–1043. [PubMed]
  • Gabriel SE, Crowson CS, O'Fallon WM. Costs of osteoarthritis: estimates from a geographically defined population. J Rheumatol Suppl. 1995 Feb;43:23–25. [PubMed]
  • Ruof J, Merkesdal S, Huelsemann JL, Schoeffski O, Maetzel A, Mau W, Zeidler H. Cost assessment instrument in rheumatology: evaluation of applied instrument characteristics. J Rheumatol. 2001 Mar;28(3):662–665. [PubMed]
  • Fautrel Bruno, Guillemin Francis. Cost of illness studies in rheumatic diseases. Curr Opin Rheumatol. 2002 Mar;14(2):121–126. [PubMed]
  • Clarke AE, Zowall H, Levinton C, Assimakopoulos H, Sibley JT, Haga M, Shiroky J, Neville C, Lubeck DP, Grover SA, et al. Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study. J Rheumatol. 1997 Jun;24(6):1051–1060. [PubMed]
  • Kobelt G, Eberhardt K, Jönsson L, Jönsson B. Economic consequences of the progression of rheumatoid arthritis in Sweden. Arthritis Rheum. 1999 Feb;42(2):347–356. [PubMed]
  • Clarke AE, Penrod J, St Pierre Y, Petri MA, Manzi S, Isenberg DA, Gordon C, Senecal JL, Fortin PR, Sutcliffe N, et al. Underestimating the value of women: assessing the indirect costs of women with systemic lupus erythematosus. Tri-Nation Study Group. J Rheumatol. 2000 Nov;27(11):2597–2604. [PubMed]
  • Koopmanschap MA, van Ineveld BM. Towards a new approach for estimating indirect costs of disease. Soc Sci Med. 1992 May;34(9):1005–1010. [PubMed]

Figures and Tables

Figure 1
Recruitment flow diagram of patients with rheumatoid arthritis (RA), osteoarthritis (OA), or high blood pressure (HBP).

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...