Daily Physical Difficulties Increase Healthcare Costs for Patients in US

Study recommends earlier intervention to improve life quality, disease burden

Marisa Wexler MS avatar

by Marisa Wexler MS |

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healthcare costs in the US | Ankylosing Spondylitis | illustration of pill bottle over money

In the U.S., people with ankylosing spondylitis who report more difficulties in their day-to-day life also tend to have higher healthcare costs, according to a new analysis.

“The results presented provide further evidence of the economic burden and increased resource use experienced by patients with more severe physical disability associated with AS [ankylosing spondylitis], which substantiates the need for earlier and more stable disease control to improve the overall quality of life and burden seen with this disease,” the researchers wrote. “Therapies for the treatment of AS that can effectively improve functional impairment may reduce costs for patients and the health care system.”

The study, “Association of health care utilization and costs with patient-reported outcomes in patients with ankylosing spondylitis,” was published in the Journal of Managed Care and Specialty Pharmacy.

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Ankylosing spondylitis is characterized by pain and inflammation in the lower back, which can cause difficulties in daily life.

Here, a team of U.S. researchers conducted an analysis to assess whether patient-reported outcomes are associated with different utilization of healthcare resources. The analysis included data collected in the 2010s from the FORWARD registry, a national databank of rheumatic diseases.

The analysis specifically assessed two patient-reported outcomes: the Health Assessment Questionnaire Disability Index (HAQ-DI) — which measures how much disease symptoms are interfering in day-to-day life — and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), which asks about the severity of disease symptoms such as fatigue, pain, and stiffness. In both scales, higher scores indicate worse outcomes.

From FORWARD, the scientists identified 253 people with ankylosing spondylitis who had completed the HAQ-DI at least once, as well as 81 patients who had completed the BASDAI. Among the patients in the analysis, 61.7% were female and 94.6% were white. The average age was 54.4 years, and average disease duration was 21.6 years.

To assess healthcare resource utilization, the researchers analyzed information such as hospitalizations and use of medications from the six months prior to the most recent assessment.

Disability scores linked to healthcare, medical, and pharmacy costs

Overall, the average healthcare cost for the patients was $44,783 per year. Most of this cost ($38,263) was attributed to pharmacy charges. The average yearly medical cost directly related to ankylosing spondylitis was $6,521, mainly attributable to hospitalizations and outpatient doctor’s visits.

Statistical analyses showed that higher (worse) scores on the HAQ-DI were significantly associated with more healthcare costs: every 1-point increase on the HAQ-DI was associated with an approximately 35% increase in costs, driven mainly by increasing non-pharmacy medical costs. Higher HAQ-DI scores also were statistically linked with more hospitalizations, outpatient visits, and diagnostic tests.

“There was a significant direct relationship between functional disability and [healthcare resource utilization] and health care costs demonstrated in this cohort,” the researchers concluded.

“A significant increase in the risk of hospitalizations, [emergency department] visits, outpatient visits, and diagnostic testing was significantly associated with HAQ-DI score. Additionally, for every 1.0-unit increase in HAQ-DI, total health care costs, medical costs, and pharmacy costs significantly increased,” they added.

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Scores on the BASDAI, however, were not significantly associated with either healthcare costs or utilization of healthcare resources. The researchers noted that these analyses were limited by the relatively small number of patients with BASDAI data available.

Other noted study limitations include the fact that the predominantly white and female population is not representative of the overall population of people with ankylosing spondylitis, and the fact that analyses assumed that patient-reported outcome measures would be relatively stable over six months when healthcare cost data was assessed.

The study was funded by pharmaceutical company Novartis.