abstract: 'Objective. With increasing interest in revising the mechanisms of health

  care funding, the ability to anticipate patients'' medical expenditures

  as well as to identify potentially modifiable predictors would be

  informative for health care providers, payers, and policy makers.

  Methods. Eight hundred fifty-eight patients with rheumatoid arthritis

  from 2 Canadian centers reported semi-annually on their health services

  utilization and health status for up to 12 years. Annual direct costs

  were calculated using 1993 Canadian prices. Regression models for the

  variation in total direct costs and the individual resource components

  (i.e., physicians, tests, medications, acute and non-acute hospital

  care) were estimated using previous values of age, sex, disease

  duration, education, methotrexate availability, employment status,

  global well being, pain, duration of morning stiffness, and functional

  disability as predictor variables. The models were developed using all

  available data except the last 2 observations (i.e., data collected on

  the last 2 self-report questionnaires) from each patient, which were

  reserved for model validation. The predictive abilities of the models

  were assessed by comparing the most recent costs with those predicted by

  the model using values of the predictor variables from the previous time

  period. Further, to assess whether the models conferred any advantage

  over cost estimates based only on previous costs, most recent observed

  costs were also compared with costs observed in the preceding time

  period.

  Results. Self-reported indices of either global well being, pain, or

  functional disability predicted total direct costs as well as the costs

  of the 5 individual resource components. Being younger, female, disabled

  from the work force, having shorter disease duration, and receiving more

  formal education also predicted higher costs in at least on health

  resource category. However, being older predicted higher acute and

  non-acute care hospital costs. Regression models incorporating

  longitudinal data did not perform better than average costs in the

  preceding rime period in predicting future short term costs.

  Conclusion. Global well being, pain, functional disability, and previous

  costs are the most important predictors of short term direct medical

  costs. Although we have demonstrated that regression models do not

  perform better than previous costs in predicting future short term

  costs, previous costs are a much less informative predictor than health

  status variables. Variables such as functional disability and pain

  identify potentially modifiable disease features and suggest

  interventions that may improve patient well being and reduce costs.'
affiliation: 'Clarke, AE (Corresponding Author), McGill Univ, Montreal Gen Hosp, Dept
  Med, Div Clin Epidemiol, 1650 Cedar Ave, Montreal, PQ H3G 1A4, Canada.

  McGill Univ, Montreal Gen Hosp, Dept Med, Div Clin Epidemiol, Montreal, PQ H3G 1A4,
  Canada.

  McGill Univ, Montreal Gen Hosp, Dept Med, Div Clin Immunol Allergy, Montreal, PQ
  H3G 1A4, Canada.

  McGill Univ, Montreal Gen Hosp, Dept Med, Div Internal Med, Montreal, PQ H3G 1A4,
  Canada.

  Univ Saskatchewan, Dept Med, Div Rheumatol, Saskatoon, SK S7N 0W0, Canada.

  Univ British Columbia, Mary Pack Arthrit Ctr, Dept Med, Div Rheumatol, Vancouver,
  BC, Canada.'
author: Clarke, AE and Levinton, C and Joseph, L and Penrod, S and Zowall, H and Sibley,
  JT and Grover, SA and Esdaile, JM
author_list:
- family: Clarke
  given: AE
- family: Levinton
  given: C
- family: Joseph
  given: L
- family: Penrod
  given: S
- family: Zowall
  given: H
- family: Sibley
  given: JT
- family: Grover
  given: SA
- family: Esdaile
  given: JM
da: '2023-09-28'
files: []
issn: 0315-162X
journal: JOURNAL OF RHEUMATOLOGY
keywords: rheumatoid arthritis; health care costs; disability; predictors
keywords-plus: 'SYSTEMIC LUPUS-ERYTHEMATOSUS; MUSCULOSKELETAL DISORDERS; DISABILITY;

  OUTCOMES; IMPACT'
language: English
month: MAY
number: '5'
number-of-cited-references: '24'
pages: 1068-1075
papis_id: 79e811417748b77e334935b021219f82
ref: Clarke1999predictingshort
times-cited: '37'
title: Predicting the short term direct medical costs incurred by patients with rheumatoid
  arthritis
type: Article
unique-id: WOS:000080003200011
usage-count-last-180-days: '0'
usage-count-since-2013: '2'
volume: '26'
web-of-science-categories: Rheumatology
year: '1999'