Abstract
The objective of this study is to review the concept of the ‘Hannover Costing Study’ and to present and discuss the major insights generated during the course of the project. The costing study was performed in conjunction with a randomized controlled prospective trial assessing the effectiveness of a disease management module in rheumatoid arthritis (RA). A full set of clinical and cost data both from patient-reported and payer-derived cost data was developed. In particular the study included (1) the development of a matrix of cost domains which might be used as a common taxonomy in costing studies, (2) the descriptive analysis of payer derived cost data, (3) the analysis of cost data in patients with uncertain diagnosis; (4) the development and validation of a patient-reported costing instrument, and (5) an assessment of productivity costs. The following are the results (1) the developed matrix of cost domains included 16 separate cost domains: 7 outpatient, 3 inpatient, 4 other disease related, and 2 productivity domains; (2) the micro-costing analysis showed total direct costs of € 3,815 per patient-year (standard error of mean, SEM: €267) and RA-related direct costs were €2,312 per patient-year; (3) in patients with uncertain diagnosis of RA and no treatment with ‘Disease Modifying Antirheumatic Drugs’ (DMARD) costs were significantly lower; (4) the comparison of patient-reported with payer-reported cost data generally supports the use of highly aggregated items to assess health care utilization in RA; (5) productivity costs in patients that are gainfully employed and in patients who receive RA-related retirement payments exceed RA-related direct costs. Furthermore, RA-patients reported their productivity losses adequately. The study added some additional insights to the following questions: What costs should be collected, what level of detail is required for that task, what patients should by analyzed, and what data sources should be used in further studies in RA.
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References
Maetzel A, Ferraz MB, Bombardier C (1998) A review of cost-effectiveness analyses in rheumatology and related disciplines. Curr Opin Rheumatol 10:136–140
Ferraz MB, Maetzel A, Bombardier C (1997) A summary of economic evaluations published in the field of rheumatology and related disciplines. Arthritis Rheum 40:1587–1593
Merkesdal S, Ruof J, Mittendorf T, Mau W, Zeidler H (2002) Health economic research in rheumatoid arthritis. Z Rheumatol 61:21–29
Rothfuss J, Mau W, Zeidler H, Brenner MH (1997) Socioeconomic evaluation of rheumatoid arthritis and osteoarthritis: a literature review. Semin Arthritis Rheum 26:771–779
Cooper NJ (2000) Economic burden of rheumatoid arthritis: a systematic review. Rheumatology (Oxford) 39(1):28–33
Pugner KM, Scott DI, Holmes JW, Hieke K (2000) The costs of rheumatoid arthritis: an international long-term view. Semin Arthritis Rheum 29(5):305–320
Kobelt G, Jonsson L, Mattiasson A (1999) Economic consequences of the progression of rheumatoid arthritis in Sweden. Arthritis Rheum 42:347–356
Meenan RF, Yelin EH, Henke CJ, Curtis DL, Epstein WV (1978) The cost of rheumatoid arthritis. A patient-oriented study of chronic disease costs. Arthritis Rheum 21:827–833
Ruof J, Hulsemann JL, Stucki G (1999) Evaluation of costs in rheumatic diseases: a literature review. Curr Opin Rheumatol 11:104–109
Mittendorf T, Merkesdal S, Huelsemann JL, von der Schulenburg JM, Zeidler H, Ruof J (2003) Implementing standardized cost categories within economic evaluations in musculoskeletal diseases. Eur J Health Econ 4(1):43–49
Huelsemann JL, Mattussek S, Hennig H, Stucki G (2003) Das Qualitätsmanagement der Therapie der chronischen Polyarthritis in der rheumatologischen Praxis. Z ärztl Fortb Qual sich 97:383–390
Uitz E, Fransen J, Langenegger, Stucki G (2000) Clinical quality management in rheumatoid arthritis: putting theory into practice. Swiss Clinical Management in rheumatoid arthritis. Rheumatology 39:542–549
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1998) The American Association 1987 revised criteria for the classifications of rheumatoid arthritis. Arthritis Rheum 31:315–324
Ruof J, Huelsemann J, Mittendorf T, Handelmann S, von der Schulenburg JM, Zeidler H, Merkesdal S (2003) Costs of rheumatoid arthritis in Germany: a micro-costing approach based on objective data sources. Ann Rheum Dis 62:544–550
Ruof J, Huelsemann J, Mittendorf T, Handelmann S, von der Schulenburg JM, Zeidler H, Aultman R, Merkesdal S (2004) Comparison of estimated medical costs among patients who are defined as having rheumatoid arthritis using three different standards. Eur J Health Econ 5:64–69
Ruof J, Merkesdal S, Hülsemann JL, Schoeffski O, Maetzel A, Mau W, Zeidler H (2001) Cost assessment instruments in rheumatology: evaluation of applied instrument characteristics. J Rheumatol 28:662–665
Ruof J, Huelsemann J, Mittendorf T, Handelmann S, von der Schulenburg JM, Zeidler H, Aultman R, Merkesdal S (2004) Patient-reported health care utilization data in rheumatoid arthritis: What level of detail is required? Arthritis Rheum 51(5):774–781
Merkesdal S, Ruof J, Huelsemann JL, Mittendorf T, Handelmann S, Mau W, Zeidler H (2005) Indirect cost assessment in patients with rheumatoid arthritis (RA): comparison of data from the health economic patient questionnaire HEQ-RA and insurance claims data, in. Arthritis Rheum 53(2):234–240
Merkesdal S, Mittendorf T, Zeidler H, Ruof J (2005) Productivity costs of RA in Germany (Article in German). Z Rheumatol (in press)
Merkesdal S, Ruof J, Huelsemann J, Maetzel A, Schoeffski O, Mau W, Zeidler H (2001) Development of a matrix of cost domains in economic evaluation of rheumatoid arthritis. J Rheumatol 28:657–661
Mittendorf T (2005) Analyses of health economic and medical data within the German health care system (Book in German). Baden-Baden, Nomos
Byford S, Torgerson DJ, Raftery J (2000) Cost of illness studies. BMJ 320:1335
Hodgson TA (1994) Cost of illness in cost-effectiveness analysis. a review of methodology. Pharmacoeconomics 6:536–552
Bloom BS, Bruno DJ, Maman DY, Jayadevappa R (2001) Usefulness of US cost-of-illness studies in healthcare decision making. Pharmacoeconomics 19:207–213
Zeidler H (1992) Epidemiology and economics of NSAID-induced gastropathy. Scand J Rheumatol Suppl 92:3–8
Pettitt D, Goldstein A, McGuire JS, Schwarzt JS, Burke T, Maniadakis N (2000) Overview of the arthritis cost consequence evaluation system (ACCESS): a pharmacoeconomic model for celecoxib. Rheumatology 39 (suppl. 2):33–42
Ritter PL, Stewart AL, Kaymaz H, Sobel DS, Block DA, Lorig KR (2001) Self-reports of health care utilization compared to provider records. J Clin Epidemiol 54:136–141
Michaud K, Messer J, Choi HK, Wolfe F (2003) Direct medical costs and their predictors in patients with rheumatoid arthritis. Arthritis Rheum 48:2750–2762
Wolfe F, Anderson J, Harkness D, Bennett RM, Caro XJ, Goldenberg DL, Russell IJ, Yunus MB (1997) A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis Rheum 40:1560–1570
Dietrich S, Schubert B, Ebner W, Daschner F (2001) Cost efficacy of tazobactam/piperacillin versus imipenem/cilastatin in the treatment of intra-abdominal infection. Pharmacoeconomics 19:79–94
Gabriel SE, Crowson CS, Campion ME, O’Fallon WM (1997) Direct medical costs unique to people with arthritis. J Rheumatol 24:719–725
Girard F, Guillemin F. Novella JL, Vlackenaere I, Krzanowska K, Virty F et al (2002) Health-care use by rheumatoid arthritis patients compared with non-arthritis subjects. Rheumatology (Oxford) 41:167–175
Huelsemann JL, Mittendorf T, Merkesdal S, Zeh S, Handelmann S, von der Schulenburg JM, Zeidler H, Ruof J (2005) Direct costs related to rheumatoid arthritis: the patient perspective. Ann Rheum Dis 64(10):1456–1461
Mittendorf T, Merkesdal S, Zeidler H, von der Schulenburg JM, Ruof J (2005) Costs of ambulatory care for RA patients in Germany. (Article in German) Med Klin (Munich) 100(5):255–261
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Hülsemann, J., Ruof, J., Zeidler, H. et al. Costs in rheumatology: results and lessons learned from the ‘Hannover Costing Study’. Rheumatol Int 26, 704–711 (2006). https://doi.org/10.1007/s00296-005-0070-7
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DOI: https://doi.org/10.1007/s00296-005-0070-7