[2008] [FRI0249] THE ECONOMIC BURDEN OF SCLERODERMA

S. Bernatsky¹, M. Hudson², P. Panopalis³, A.E. Clarke⁴, J. Pope⁵, S. Leclercq⁶, D. Robinson⁷, N. Jones⁸, J. Markland⁹, M. Abu-Hakima⁶, J. Mathieu¹⁰, P. Docherty¹¹, N. Khalidi¹², E. Sutton¹¹, M. Baron², Csrg^{13 1}Epidemiology and Rheumatology; ²Rheumatology, McGill University, Montreal, Canada; ³Rheumatology, University of California, San Francisco, United States; ⁴Divisions of Clinical Allergy/Immunology and Epidemiology, McGill University, Montreal; ⁵Rheumatology, University of Western Ontario, London; ⁶Rheumatology, University of Calgary, Calgary; ⁷Rheumatology, University of Manitoba, Winnipeg; ⁸Rheumatology, University of Alberta, Edmonton; ⁹Rheumatology, University of Saskatchewan, Saskatoon; ¹⁰Rheumatology, University of Montreal, Montreal; ¹¹Rheumatology, University of Dalhousie, Halifax; ¹²Rheumatology, McMaster University, Hamilton; ¹³Canadian Scleroderma Research Group, National Registry, Canada

Background: Systemic sclerosis (SSc) is a multi-system autoimmune rheumatic disease with considerable morbidity. However, published data related to the economic burden of SSc is limited.
Objectives: To assess the economic burden of SSc in a large unselected sample of patients by generating data on components of direct medical cost.
Methods: The Canadian Scleroderma Research Group (CSRG) is a network of 13 centres contributing to a registry of adult SSc patients. Data collected at baseline and follow-up include clinical variables and standardized measures of health resource utilization. Average annualized costs of direct medical cost components (health professional visits, diagnostic tests, outpatient surgeries, hospitalizations) were calculated by multiplying health service utilization levels by the appropriate unit prices, which were determined from government fee schedules (e.g. for physician services), professional associations (e.g. for non-physician services), provincial insurance programs (e.g. assistive devices)and other sources. Figures represent costs in 2007 Canadian dollars.
Results: Data are presented on all SSc patients (n=457)providing data on health resource use. The majority of the SSc subjects were female (87.5%) and white (87.9%). The average age of the SSc subjects was 55.1 years (standard deviation, SD, 12.1years); the average disease duration was 8.1 (SD 7.7) years. Regarding economic burden, the average cost (per patient) for visits to health care professionals was $756 per year (95% confidence interval, CI, $638, 875); for diagnostic tests, $736 per year ($ 643, 828); and for hospitalizations, $1,540 per year ($1154, 1925). The total annual average for these direct medical cost components, in 2006 Canadian dollars, was $3,462 ($3000, 3925) per patient. When the SSc patients were stratified into diffuse versus limited disease, cost estimates were similar between the two groups. The table below provides a comparison of these average annual costs in SSc versus what has been reported in rheumatoid arthritis (RA).

Yearly averages for some components of direct medical cost in SSc versus RA

	SSc (N=457) (Current study)		RA** Ave. annual cost*
	Ave. annual cost*	95% CI	Ave. annual cost*	95% CI
Visits to health care professionals	756	(638, 875)	498	(489,507)
Diagnostic tests	736	(643, 828)	559	(523, 585)
Outpatient surgeries	222	(165, 280)	81	(78, 91)
Hospitalizations	1,540	(1154, 1925)	1,162	(1,071, 1254)
Total	3,254	(3000, 3925)	2,301	(2,162, 2437)

*Figures represent 2007 Cdn dollars. **Based on published literature.

Conclusion: These results indicate significant medical costs in SSc. Our estimates of annual averages for direct medical cost components in SSc suggest that the economic burden of SSc may exceed that of RA. Further work is in progress to more completely define the economic burden of SSc in our sample.

Ann Rheum Dis 2008;67(Suppl II):363

Scleroderma, Myositis and related syndromes