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Cost of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus in Germany
  1. D Huscher1,
  2. S Merkesdal2,
  3. K Thiele2,
  4. H Zeidler2,
  5. M Schneider3,
  6. A Zink3,
  7. for the German Collaborative Arthritis Centres*
  1. 1German Rheumatism Research Centre, Berlin, Germany
  2. 2Medizinische Hochschule, Hannover, Germany
  3. 3Heinrich-Heine-Universitaet, Duesseldorf, Germany
  1. Correspondence to:
    A Zink
    Deutsches Rheuma-Forschungszentrum Berlin, Forschungsbereich Epidemiologie, Schumannstr. 21/22, D 10117 Berlin, Germany; Zink{at}


Objective: To estimate and compare the direct and indirect costs of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE), and to evaluate the effect of sex, disease duration and functional status on the various cost domains.

Methods: Data of outpatients, aged 18–65, with rheumatoid arthritis (n = 4351), ankylosing spondylitis (n = 827), PsA (n = 908) or SLE (n = 844), who were enrolled in the national database of the German collaborative arthritis centres in 2002, were analysed. Data on healthcare consumption, out-of-pocket expenses and productivity losses were derived from doctors and patients. For the calculation of indirect costs, the human capital approach (HCA) and the friction cost approach (FCA) were applied.

Results: Mean direct costs amounted to €4737 a year in rheumatoid arthritis, €3676 in ankylosing spondylitis, €3156 in PsA and €3191 in SLE. By using the HCA, total costs were calculated at €15 637 in rheumatoid arthritis, €13 513 in ankylosing spondylitis, €11 075 in PsA and €14 411 in SLE, whereas with the FCA the numbers were €7899, €7204, €5570 and €6518, respectively. Costs increased with disease duration and were strongly dependent on functional status. In patients with the highest disability (<50% of full function), the total costs on applying the HCA were €34 915 in rheumatoid arthritis, €29 647 in alkylosing spondylitis, €37 440 in PsA and €32 296 in SLE.

Conclusion: The costs of illness are high in all four diseases, with a strong effect of functional status on total costs. Indirect costs differ by the factor 3, based on whether the HCA or the FCA is used.

  • FCA, friction cost approach
  • FFbH, Hannover Functional Status Questionnaire
  • HAQ, Health Assessment Questionnaire
  • HCA, human capital approach
  • PsA, psoriatic arthritis
  • SLE, systemic lupus erythematosus

Statistics from


  • * Participating German Collaborative Arthritis Centres (speakers): Aachen/Koeln/Bonn (E Genth), Berlin (J Sieper), Dresden (HE Schroeder), Duesseldorf (M Schneider), Erlangen (B Swoboda), Essen (C Specker), Gießen/Bad Nauheim (KL Schmidt), Greifswald (H Merk), Hannover (H Zeidler), Heidelberg (U Schneider), Jena (G Hein), Leipzig (H Haentzschel), Luebeck/Bad Bramstedt (WL Gross), Magdeburg/Vogelsang (J Kekow), Mainz/Bad Kreuznach (R Dreher), Muenchen (M Schattenkirchner), Muenster (M Gaubitz), Ostwestfalen/Lippe (H Mielke), Regensburg/Bad Abbach (U Mueller-Ladner), Rhein-Main (JP Kaltwasser), Rostock (M Keysser), Saarland (M Pfreundschuh), Suedbaden (HH Peter) and Suedwuerttemberg (R Maleitzke)

  • Published Online First 15 March 2006

  • Competing interests: None declared.

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