Diagnosis and referral of rheumatoid arthritis by primary care physician: results of a pilot study on the city of Pisa, Italy

Abstract

The aims of the present study were to evaluate, in the city of Pisa: (1) the prevalence of rheumatoid arthritis; (2) the reliability of the prevalence estimated by primary care physicians, using the rheumatologist's diagnosis as the "gold standard" and (3) the economic impact of the disease. The Tuscany registry of primary care physicians constituted the framework from which a sample of subjects was selected. The rheumatoid arthritis (RA) subjects >18 years followed by each primary care physician constituted the population studied. Each general practitioner (GP) was asked to fill out a questionnaire regarding their patients affected by RA and to send it to the tertiary rheumatologic centre, where the diagnosis was confirmed/discarded, the clinical and epidemiological data were collected in a standardized form and a number of data for the estimation of costs were gathered. The estimated prevalence of RA was 5.1 per thousand (CI, 4.4-5.7). The reliability of general practitioners in the diagnosis of rheumatoid arthritis was on the whole 69%. However, when an analysis of every physician was carried out, a high degree of heterogeneity in the prevalence of RA per physician was found. Overall, the mean annual cost per patient with RA was estimated at about 5,878 euro (euro; median, 6,434 euro; inter quartile range, 669-7,052 euro), with a high variability mainly dependent on the degree of patient disability. More than 90% of the overall annual cost per patient was due to the medical and non-medical direct components of costs. The prevalence of RA in Tuscany seems highly comparable with similar prevalence studies in Italy. The annual cost per patient with RA was highly variable and strictly dependent on the level of disability. More than 90% of the overall cost was due to the direct burden of costs.

Cost Effectiveness Analysis of Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis. A Systematic Review Literature

“…Recent Italian population data have shown that the prevalence of RA has increased to 0.49% [7], in line with the findings of epidemiological studies carried out in the United State (US) [8]. The incidence of new cases is increasing [9], but it has not been followed by an increase in the use of biological therapy, which was prescribed for only 6.3% of RA patients in 2009 [10].…”

Patterns of Disease‐Modifying Antirheumatic Drug Use in Rheumatoid Arthritis Patients After 2002: A Systematic Review

“…Three studies conducted population‐based surveys to define cases of RA (). Again, these patients were followed up by a mixed group of providers (Table ).…”

Costs associated with rheumatoid arthritis in Italy: past, present, and future

“…Another study carried out in the province of Pisa in the years 2006 and 2007 14 evaluated the prevalence of RA, the reliability of the RA diagnosis and prevalence estimated by general practitioners (GPs), and the economic impact of the disease in a total of 26,709 subjects aged over 18 years. Each GP completed a questionnaire on their patients; patients considered by GPs to have RA were then invited to attend an appointment at a specialist rheumatology center for confirmation or rejection of the diagnosis made.…”

“…In a health economic analysis carried out in the province of Pisa in the years 2006 and 2007, 14 the mean annual cost per patient with RA was estimated to be €5,878 (median €6,434; interquartile range €669–€7,052), with high variability, mainly depending on the degree of disability. In this analysis, more than 90% of the overall annual cost per patient was due to the medical and nonmedical components of direct costs.…”