EXTENDED REPORT

¹ Department of Medicine, Lappeenranta Central Hospital, Lappeenranta, Finland
² Rheumatism Foundation Hospital, Heinola, Finland
³ Centre for Health Economics at STAKES (National Research and Development Centre for Welfare and Health), Helsinki, Finland
⁴ Department of Medicine, Turku University Central Hospital, Turku, Finland
⁵ Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
⁶ Department of Rheumatology, Tampere University Hospital, Tampere, Finland
⁷ Department of Rheumatology, Rauma Hospital, Rauma, Finland
⁸ Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

Correspondence to:
Dr K Puolakka
Department of Medicine, Lappeenranta Central Hospital, Valto Käkelän katu 1, Lappeenranta FIN-53130, Finland; kari.puolakka{at}fimnet.fi

Objective: To explore the monetary value of rheumatoid arthritis related loss of productivity in patients with early active disease.

Methods: In a prospective cohort substudy of the FIN-RACo Trial, 162 patients with recent onset rheumatoid arthritis, aged 18 to 65 years and available to the workforce, were followed up for five years. Loss of work productivity in euros 2002 was estimated by data on absence for sickness and on income (human capital approach) from official databases. Treatment responses were evaluated by area under the curve (AUC) of the ACR-N measure and by increase in number of erosions in radiographs of hands and feet. The health assessment questionnaire (HAQ) at six months was linked to the International Classification of Functioning, Disability and Health (ICF).

Results: In all, 120 (75%) patients, women more often (82%) than men (61%) (p = 0.002), lost work days. The mean lost productivity per patient-year was 7217 (95% confidence interval (CI), 5561 to 9148): for women, 6477 (4858 to 8536) and for men, 8443 (5389 to 12 898). There was an inverse correlation with improvement: 1101 (323 to 2156) and 14 952 (10 662 to 19 852) for the highest and lowest quartiles of AUC of ARC-N, respectively. Lost productivity was associated with increase in the number of erosions and with disability in "changing and maintaining body position" subcategory of the ICF.

Conclusions: Despite remission targeted treatment with disease modifying antirheumatic drugs, early rheumatoid arthritis results in substantial loss of productivity. A good improvement in the disease reduces the loss markedly.

Abbreviations: ACR, American College of Rheumatology; AUC, area under the curve; DMARD, disease modifying antirheumatic drug; FCA, friction cost approach; FIN-RACo, Finnish Rheumatoid Arthritis Combination-Therapy Trial; HCA, human capital approach; HAQ, Health Assessment Questionnaire; ICF, International Classification of Functioning, Disability and Health

Keywords: rheumatoid arthritis; lost productivity; work disability; human capital approach; ICF

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