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Societal costs and patients' experience of health inequities before and after diagnosis of psoriatic arthritis: a Danish cohort study
  1. Lars Erik Kristensen1,
  2. Tanja S Jørgensen1,
  3. Robin Christensen1,
  4. Henrik Gudbergsen1,
  5. Lene Dreyer1,2,
  6. Christine Ballegaard1,
  7. Lennart T H Jacobsson3,
  8. Vibeke Strand4,
  9. Philip J Mease5,
  10. Jakob Kjellberg6
  1. 1The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Denmark
  2. 2Gentofte Hospital, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Hellerup, Denmark
  3. 3Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  4. 4Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
  5. 5Swedish Medical Center and University of Washington, Seattle, Washington, USA
  6. 6Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
  1. Correspondence to Dr Lars Erik Kristensen, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Nordre Fasanvej 57, Road 8, Entrance 19, DK-2000 Frederiksberg, Denmark; lars.erik.kristensen{at}regionh.dk

Abstract

Objectives To comprehensively study the comorbidities, healthcare and public transfer (allowance) costs in patients with psoriatic arthritis (PsA) before and after diagnosis.

Methods Nationwide cohort study, using data from Danish registries from January 1998 through December 2014. A total of 10 525 patients with PsA and 20 777 matched general population comparator (GPC) subjects were included. Societal costs, employment status and occurrence of comorbidities in patients with PsA both before and after diagnosis were compared with GPC subjects.

Results At baseline, patients with PsA had significantly more comorbidities, including cardiovascular disease (OR 1.70 95% CI 1.55 to 1.86), respiratory diseases (OR 1.73 95% CI 1.54 to 1.96) and infectious diseases (OR 2.03 95% CI 1.69 to 2.42) compared with GPC subjects. At all time points, patients with PsA had higher total healthcare and public transfer costs; they also had lower income (p<0.001) and incurred a net average increased societal cost of €10 641 per patient-year compared with GPC subjects following diagnosis. The relative risk (RR) for being on disability pension 5 years prior to PsA diagnosis was 1.36 (95% CI 1.24 to 1.49) compared with GPC subjects. The RR increased to 1.60 (95% CI 1.49 to 1.72) at the time of diagnosis and was 2.69 (95% CI 2.40 to 3.02) 10 years after diagnosis, where 21.8% of the patients with PsA received disability pension.

Conclusions Our findings are suggestive of health inequity for patients with PsA and call for individual preventive measures and societal action.

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Footnotes

  • Handling editor Tore K Kvien

  • Contributors LEK: contributed to study conception and design, literature search, data collection, the analysis and interpretation of data, figures, drafting the manuscript and approving the final version. LEK takes responsibility for all coauthors and the integrity of the work as a whole. TSJ: contributed to study conception and design, the analysis and interpretation of data, figures, revising the manuscript and approving the final version. TSJ had access to data throughout the process and knowledge of roles and responsibilities of each author. HG: contributed to study conception and design, data collection, the analysis and interpretation of data, revising the manuscript and approving the final version. HG had access to data throughout the process and knowledge of roles and responsibilities of each author. LD: contributed to study conception and design, data collection, the analysis and interpretation of data, revising the manuscript and approving the final version. LD had access to data throughout the process and knowledge of roles and responsibilities of each author. RC: contributed to study conception and design, literature search, data collection, the analysis and interpretation of data, revising the manuscript and approving the final version. RC had access to data throughout the process and knowledge of roles and responsibilities of each author. CB: contributed to study conception and design, data collection, the analysis and interpretation of data, revising the manuscript and approving the final version. CB had access to data throughout the process and knowledge of roles and responsibilities of each author. LTHJ: contributed to interpretation of data, drafting and revising the manuscript and approving the final version. LTHJ had access to data throughout the process and knowledge of roles and responsibilities of each author. VS: contributed to interpretation of data, drafting and revising the manuscript and approving the final version. VS had access to data throughout the process and knowledge of roles and responsibilities of each author. PJM: contributed to interpretation of data, drafting and revising the manuscript and approving the final version. PJM had access to data throughout the process and knowledge of roles and responsibilities of each author. JK: contributed to study conception and design, data collection, the analysis and interpretation of data, figures, drafting the manuscript and approving the final version. JK takes responsibility for all coauthors and the integrity of the work as a whole.

  • Funding This study was funded by the NordForsk Foundation, Oak Foundation and Novartis Pharmaceuticals. The funders had no role in the study design, data collection, data analysis, data interpretation or writing of the report. LEK and JK had full access to all the data in the study, had final responsibility for the decision to submit the publication and take responsibility for all coauthors and the integrity of the work as a whole. Oak foundation number: OCAY-13-309.

  • Competing interests LEK, LTHJ, VS, PJM, and RC have received fees for speaking and consultancy by Pfizer, AbbVie, Amgen, UCB, Celegene, BMS, MSD, Novartis, Eli Lilly and Janssen Pharmaceuticals. TSJ has received fees for speaking and consultancy by AbbVie, Roche and Novartis. HG has received fees for speaking by Pfizer. LD has received fees for speaking and consultancy by UCB, MSD and Janssen.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unidentified and additional raw data making the basis for this work can be requested after proper correspondence with LEK, and under the extent possible according to national Danish law.

  • Transparency statement LEK affirms that the manuscript is honest, accurate and in accordance with the prespecified protocol, which can be accessed in the online supplementary material or as open access at http://www.parkerinst.dk. No important aspects of the study have been omitted in the current manuscript.

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