BackgroundOsteoarthritis (OA), as a common joint's disease, is associated with high healthcare resource utilization. It is important to determine the economic burden of the disease and the possible predictors which may increase the cost of the disease.ObjectivesTo estimate the total annual costs and their predictors in patients with knee osteoarthritis in our country.MethodsA cross-sectional study was performed from January 2012 to January 2013. There were included consecutive patients that fulfilled the ACR classification criteria for knee OA (1991). We collected data on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. The direct medical costs comprised: medication, hospitalization, medical visits and investigations; the direct non-healthcare costs included informal care and patient out-of-pocket payments. Human capital approach was used to estimate indirect costs. Mean annual per patient total costs were calculated from a patient's perspective. The intangibles costs were assessed by Willingness to Pay method. The cost's predictors were determined by multiple regression analyses using direct, indirect and total costs as outcome variables. This study was conducted according to the principles of the Declaration of Helsinki (1996) and good clinical practice.ResultsThere were 256 patients integrated in the study including 196 females and 60 males, mean age 62.4±9.5 (range 37 to 85) years. The disease duration was 8.1±6.7 (range 1-51) years. The average total cost, accounted $685, including: the direct costs - $485 (71.04%) per person per year and indirect costs - $190 (29%), respectively. The mean intangible cost was $1200, with a large range ($83 -$8400).Female gender, educational level and higher annual incomes caused an increase of direct costs (p<0.001). The indirect costs were higher in patients with radiographic severe disease (p<0.05), poor joint functionality (p<0.01) and the presence of co-morbidities (p<0.01). The intangibles costs were influenced by the pain level (p<0.05).ConclusionsThe knee osteoarthritis has a considerable economic burden on patient and health-care system. The maintenance of joint mobility and the control of disease progression may reduce the costs of knee osteoarthritis.Disclosure of InterestNone declared

Background Osteoarthritis (OA) is associated with healthcare resource utilization and loss or worker productivity. The total direct and indirect costs of OA can differ substantially across systems. No data as yet are available on economic impact of OA in Republic of Moldova. Objectives To estimate the direct and indirect costs of knee osteoarthritis in Republic of Moldova. Methods A cross-sectional study was performed from January 2012 to January 2013. There were included 256 patients that fulfilled the ACR classification criteria for knee OA (1991). The direct medical costs comprised: medication, hospitalization, medical visits and investigations; the direct non-healthcare costs included informal care and patient out-of-pocket payments. Human capital approach was used to estimate indirect costs by multiplying: 1) days of absence from work because of OA, with average earnings per capita per day for working patients; or 2) productivity loss with the market price of housekeeping for retirees/homemakers. Mean annual per patient costs were calculated from an employer's perspective. Correlations were also calculated between the costs and quality of life (QoL) that was assessed by KOOS- Knee injury and Osteoarthritis Outcome Score (100% high QoL). Results There were 256 patients integrated in the study including 196 females and 60 males, mean age (SD) 62.4 (9.5) years (range 37 to 85 years). The disease duration (SD) was 8.1 (6.7) years (range 1-51).The KOOS results showed that the QoL constituted 35.7%, qualified as low. The average total cost excluding joint replacement, accounted $685, and the direct costs represented 71.04% (mean $485) per person per year and indirect costs - 29% ($190), respectively. The direct costs represented 18.4% of annual incomes, the insurance cover just 50.7% from direct costs. The three major components of direct costs were hospitalization (48.3%), drug cost (26.4%) and informal care (13%). We established moderate correlation between direct costs and QoL (r=0.4, p<0.05), therefore the indirect costs were strongly correlated with quality of life level (r=0.7, p<0.05). Conclusions The direct costs of osteoarthritis in the Republic of Moldova population are high being comparable to those reported in European countries and the economic burden is important by relatively high out-of-pocket expenditures. The indirect costs are not a major component of the cost of illness; this is mainly due to the low monetary value of paid work. Both types of costs correlated with the quality of life. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2527

BackgroundPatients with systemic lupus erythematosus have a very high burden of comorbidities. Identification and management of these comorbidities are critical for optimal medical care to this population.ObjectivesTo assess the prevalence of comorbidities in SLE patients with pulmonary involvement.MethodsIn a cross-sectional study, patients who fulfiled the SLICC (2012) classification criteria for SLE, were recruited from Rheumatology Departement. Data collection included demographics, disease duration, physician-rated indices of disease activity (by SLAM), damage (by SLICC/ACR DI) and Charlson comorbidity Index. The pulmonary involvement was assessed by chest X-ray, EcoCG Doppler and pulmonary functional tests.ResultsThe study included 106 patients (97 women, 9 males) with a mean age (±SD) of 41,1±12,6 yrs, mean disease duration of 90,3±87,3 months. The disease activity by SLAM was 11±5,17 points and mean SLICC/ACR DI 1,9±2,4 points (66% of patients had at least 1 point). Pulmonary assessment revealed that 45 (42,5%) patients had different types of pulmonary involvement due to lupus: pleuritis - 24 patients, pneumonitis – 1 patient, pulmonary embolism – 4 patients, interstitial lung disease – 15, shrinking lung syndrome – 1 and pulmonary arterial hypertension – 9 patients. The most frequent comorbidities in study group were: arterial hypertension - in 57 (53,7%) cases, from which 33 (57,9%) patients had pulmonary involvement and 24 (42,1%) without, obesity (BMI>30 kg/m2) had 29 (27,4%) patients, from which 17 (58,6%) with lung involvement and 12 (41,4%) without, anemia (Hb<110g/l) had 24 (22,6%) patients, from them 14 (58,3%) with lung disease and 10 (41,7%) patients - without, heart failure (I-II NYHA) had 23 (21,7%) patients, from them 20 (86,9%) were with lung implication, thyroiditis had 22 (20,8%) and 15 (68,2%) of them were with pulmonary involvement, diabetes mellitus type II had only 6 (5,7%) patients and half of them had lung disease. Assessing the impact of associated diseases through Charlson comorbidity index, we found that the score for patients diagnosed with damage to the respiratory system was twice as big vs. patients without respiratory impairment from SLE (6,3±2,4 vs. 3,4±1,4 points). Also, Charlson comorbidity score ≥1 was identified as a risk factor for lung involvement (OR 5,5294, 95% CI 2,367 – 12,91, p<0,01). Evaluation of disease activity by SLAM showed that patients with lung involvement have a higher disease activity vs. patients without (13,9±6,0 vs. 8,9±4,0, p<0,05).ConclusionsOn the one hand, according to our results patients with SLE and pulmonary involvement have a higher prevalence of comorbidities comparative with patients without them. Hypertension was found to be the most common comorbidity and it was determined in 73,3% of patients with impaired respiratory system (p<0,01). On the other hand, association of comorbidities (Charlson comorbidity score ≥1) was identified as a risk factor for lung lesions.References Rees F., Doherty M., Grainge M. et al. The Burden of Comorbidity ...

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BackgroundInterest in patient satisfaction with medical care increased in the last few years and it can be due to numerous factors, including concerns over health care cost, heightened awareness of the influence of psychosocial factors in the process and outcome of medical care [1]. A group of researchers have shown that patient dissatisfaction with health care has been related to patient non-compliance with medical treatment, discontinuation of care and frequent changing of health care providers [2]. We found a few publications related to the satisfaction in patients with systemic lupus erythematosus (SLE), but is not clear how the disease activity is related to the patient satisfaction.ObjectivesTo assess the relationship between patient satisfaction with medical care and disease activity among patients with systemic lupus erythematosus.MethodsUsing a cross-sectional design, patients who fulfiled the SLICC classification criteria for SLE were recruited from rheumatology departement. Data collection included demographics, disease duration, phisician-rated indices of disease activity (SLAM), damage (SLICC DI) and patient-completed satisfaction questionaire (PSQ III) [3].ResultsThe study included 106 patients (97 women, 9 mens) with a mean age (±SD) of 41,1±12,6 yr, mean disease duration of 90,0±87,2 months. The disease activity by SLAM was 11±5,17 points and mean SLICC/ACR DI 1,9±2,4 points. Multiple regression analysis revealed that the only determinant for a reduction in general patient satisfaction with medical care was the disease activity by SLAM (r=-0,4, p<0,05). Also, financial aspects of care correlated inversely with higher disease activity and age of patients with SLE (r=-0,4, p<0,05). The other variables included in the regression model seem not to have an impact on satisfaction with medical care.ConclusionsThe disease activity was predictive for patient dissatisfaction with medical care among SLE patients. Higher disease activity and older age were associeted with financial aspect of medical service.ReferencesShelbourne CD, Hays RD, Bourton T. Population-based surveys of access and consumer satisfaction with health care. In: Rockville, MD: Agency for Health Care Policy and Research, 1994.Cameron C. Patient compliance: recognition of factors and suggestions for promoting compliance with therapeutic regimens. In: J Adv Nurs, 1996; vol. 24, p. 244-250.Ware, JE, Snyder, MK, Wright, WR. Development and Validation of Scales to Measure Patient Satisfaction with Medical Care Services (1976) Vol I, Part B: Results Regarding Scales Constructed from the Patient Satisfaction Questionnaire and Measures of Other Health Care Perceptions. (NTIS Publication No. PB 288-329). Springfield, VA. National Technical Information Service.Disclosure of InterestNone declared