Ann Rheum Dis 62:741-747 doi:10.1136/ard.62.8.741
  • Extended report

Costs of ankylosing spondylitis in three European countries: the patient’s perspective

  1. A Boonen1,
  2. D van der Heijde1,
  3. R Landewé1,
  4. F Guillemin2,
  5. A Spoorenberg1,
  6. H Schouten3,
  7. M Rutten-van Mölken4,
  8. M Dougados5,
  9. H Mielants6,
  10. K de Vlam6,
  11. H van der Tempel7,
  12. Sj van der Linden1
  1. 1Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, The Netherlands
  2. 2EA 3444- Department of Clinical Epidemiology and Evaluation, University Hospital Nancy, France
  3. 3Department of Methodology and Statistics, University of Maastricht, The Netherlands
  4. 4Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
  5. 5Department of Rheumatology, Université Réné Descartes, Hôpital Cochin, Paris, France
  6. 6Department of Rheumatology, University Hospital Gent, Belgium
  7. 7Maasland Ziekenhuis Sittart, The Netherlands
  1. Correspondence to:
    Dr A Boonen, Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands;
  • Accepted 20 January 2003


Objective: To assess a patient’s out of pocket costs, income loss, time consumption, and quality of life (QoL) due to ankylosing spondylitis (AS) in three European countries and to assess variables predicting these outcomes.

Methods: 216 patients with AS from the Netherlands, France, and Belgium participated in a two year study. Health resource use, days absent from work, time lost, and quality of life (EuroQol) were assessed by bimonthly questionnaires. AS related healthcare and non-healthcare expenditure and income loss were calculated taking into account country-specific regulations. Predictors of costs, time consumption, and QoL were analysed by Cox’s regression.

Results: 209 patients provided data for cost analysis. Average annual healthcare and non-healthcare expenditure was €431 per patient and average annual income loss was €1371 per patient. Healthcare costs were highest for Belgian and lowest for French patients, while non-healthcare costs were highest for Dutch patients. A patient’s total costs were associated with higher age and worse physical function. On average, patients with AS needed 75 minutes additional time a day because of AS. Worse physical function and higher disease activity predicted time consumption. After adjusting for baseline confounders, QoL was worse in Belgian and French than in Dutch patients. Peripheral arthritis, worse physical function, higher disease activity, and loss of income contributed to worse QoL.

Conclusion: AS is time consuming and associated with substantial out of pocket costs. Belgian patients incur the highest healthcare payments. Poor physical function increases patient’s costs and time consumption. Loss of income is associated with lower QoL.