Mark Prashker

The costs of rheumatoid arthritis.

SummaryThe economic costs associated with rheumatoid arthritis (RA). a chronic. systemic. inflammatory disorder that affects many joints. are high. approximating those of coronary heart disease. The estimated prevalence of RA in the US is 0.9%. Incidence increases with age. and is highest among women in the fourth to sixth decades of life, The primary impact of RA is due to the significant morbidity associated with this disease. Mortality is increased among a poorly defined subgroup of RA patients. The average level of disability among RA patients is moderate. but 6.5 to 12% of patients are severely disabled. Between one- and two-thirds of prev iously employed patients have a reduced work capacity.Treatment primarily involves the use of nonsteroidal anti -inflammatory drugs and disease modifying <lntirheumatic drugs. Rehabilitation measures and orthopaedic surgery are also used. Total annual direct costs of RA (total charges) have been calculated to be

Subspecialty training: is it financially worthwhile?

US5275 and

Pharmacoeconomic Evaluation of Antidepressants A Critical Appraisal of Methods

US6099 ( 1991 dollars) per patient. Lifetime medical care charges were estimated at SUS 12578 per patient (1991 dollars).The dircct costs of RA are substantial, but indirect costS have been calculated to be much higher because of extensive morbidity. The difference between the direct and indirect costs of RA is decreasing because salary increases have nOi kept pace with risin g heahhcare costs. The latter arc increasing rapidly in RA because of the use of new technology. surgical procedures. and the greater use of drugs with frequent monitoring requirements and significant toxicity. Because intangible costs such as pain form a substantial part of the overall costs ofRA but are difficult to evaluate. cost estimates inevitably underestimate the impact of the disease on individuals and society.

Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis

OBJECTIVE To determine the financial return of additional training in a cognitive-oriented medical subspecialty (rheumatology) and in a procedure-oriented medical subspecialty (gastroenterology) relative to general internal medicine. DESIGN Analysis of existing data to compare lifetime discounted earnings of physicians in different medical specialties. PARTICIPANTS General internists, gastroenterologists, and rheumatologists were surveyed. MAIN OUTCOME MEASURES Using data from surveys conducted by Medical Economics and the American College of Rheumatology, we constructed lifetime earnings streams that allowed the calculation of the net present values of discounted lifetime earnings in general internal medicine, gastroenterology, and rheumatology. Net present values of lifetime earnings were calculated for each group at two discount rates. Sensitivity analyses were done to estimate how changes in relative income would affect calculations of the net present values. MAIN RESULTS The average net incomes before taxes for general internists, gastroenterologists, and rheumatologists in 1988 were

The total costs of drug therapy for rheumatoid arthritis

115,825,

The efficacy and cost effectiveness of N of 1 studies with diclofenac compared to standard treatment with nonsteroidal antiinflammatory drugs in osteoarthritis.

201,875, and

The cost‐effectiveness of liver biopsy in rheumatoid arthritis patients treated with methotrexate

118,056, respectively. At 5% and 10% discount rates, the net present values of the estimated career earnings stream for additional training in gastroenterology relative to general internal medicine were +

Relative costs and effectiveness of specialist and general internist ambulatory care for patients with 2 chronic musculoskeletal conditions.

1,101,863 and +

Reading and interpreting economic evaluations in rheumatoid arthritis: an assessment of selected instruments for critical appraisal.

512,952, respectively; for additional training in rheumatology relative to general internal medicine, the respective values were -

The Direct Costs of Fibromyalgia Treatment

84,748 and -