84 Russell DMARDs is comparable to that of other well ac- cepted interventions in other disease conditions. iSC.M ed qua 7.Conclusions 3 RA is a chronic disease that has a detrimental 4. 6(6513-22 quenc of RA are devas on is ng to ou function and OOL.which are not ade nc 5( ated using current clinical criteria.However.despite the availability of patient-reported outcomes for as- sessment.they have yet to be incorporated into 206849.68 8. clinical practice as part of the regularly scheduled evaluation.The use of patient-reported outcomes ical when com- Despite a relatively large available pharmacological the s,a proportion of patients with RA are refractory to both non-biologi- 2. DT.A M.et al an Coll are incorporated into clinical 3. practice,patients with RA are increasingly likely to nent of achie ents in fun proa se of 14.Den Broeder Ae h While these benefits at additio cost th INF-alphRheu may be related to the high acquisition costs of these drugs,other economic factors should also be consid- 15.Kha ered,including the overall impact of treatment on direct costs such as healthcare resource utilization .Weeks C.GuadagnoliE et al.Using health- and indirect costs that may be related to productivity M19940g0576 and improved QOL. icy.Gen Inte min F.F Acknowledgements 18.Lu 19.Lubeck DP.Patient-re B.Mintz A.et al.The res gRR References 21.Co s SI Rao S.K844 Russell DMARDs is comparable to that of other well ac- mortality in a community based cohort of patients with rheu￾matoid arthritis. J Rheumatol 2002 Jan; 29 (1): 62-7 cepted interventions in other disease conditions. 2. Kosinski M, Kujawski SC, Martin R, et al. Health-related quali￾ty of life in early rheumatoid arthritis: impact of disease and treatment response. Am J Manag Care 2002 Mar; 8 (3): 231-40 7. Conclusions 3. Fautrel B, Guillemin F. Cost of illness studies in rheumatic diseases. Curr Opin Rheumatol 2002 Mar; 14 (2): 121-6 RA is a chronic disease that has a detrimental 4. Allaire SH, Prashker MJ, Meenan RF. The costs of rheumatoid impact on the QOL of patients and places a substan- arthritis. Pharmacoeconomics 1994 Dec; 6 (6): 513-22 5. Gremillion RB, van Vollenhoven RF. Rheumatoid arthritis: tial burden on families, society and the healthcare designing and implementing a treatment plan. Postgrad Med system. Because the consequences of RA are devas- 1998 Feb; 103 (2): 103-6, 10, 18 tating to the individual, attention is shifting to out- 6. Bansback NJ, Regier DA, Ara R, et al. An overview of econom￾ic evaluations for drugs used in rheumatoid arthritis: focus on comes of particular relevance to patients, such as tumour necrosis factor-alpha antagonists. Drugs 2005; 65 (4): function and QOL, which are not adequately evalu- 473-96 ated using current clinical criteria. However, despite 7. Raza K, Buckley CE, Salmon M, et al. Treating very early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2006 Oct; the availability of patient-reported outcomes for as- 20 (5): 849-63 sessment, they have yet to be incorporated into 8. Guidelines for the management of rheumatoid arthritis: 2002 clinical practice as part of the regularly scheduled update. Arthritis Rheum 2002 Feb; 46 (2): 328-46 9. The World Health Organization Quality of Life assessment evaluation. The use of patient-reported outcomes (WHOQOL): position paper from the World Health Organiza- can be useful in providing the patient’s perspective tion. Soc Sci Med 1995 Nov; 41 (10): 1403-9 on the potential benefits of therapy and, when com- 10. Kvien TK, Uhlig T. Quality of life in rheumatoid arthritis. Scand J Rheumatol 2005 Sep-Oct; 34 (5): 333-41 bined with clinical outcomes, can provide a compre- 11. US Food and Drug Administration. Guidance for industry pa- hensive evaluation of the disease and its treatment. tient-reported outcome measures: use in medical product de￾Despite a relatively large armamentarium of velopment to support labeling claims [online]. Available from URL: http://www.fda.gov/cder/guidance/5460dft.htm. [Ac- available pharmacological therapies, a proportion of cessed 2007 Oct 11] patients with RA are refractory to both non-biologi- 12. Felson DT, Anderson JJ, Boers M, et al. American College of cal and biological DMARDs. However, as new bio- Rheumatology: preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 1995 Jun; 38 (6): 727-35 logical DMARDs are incorporated into clinical 13. Department of Rheumatology, University Medical Centre. practice, patients with RA are increasingly likely to DAS-Score.nl: disease activity score in rheumatoid arthritis [online]. Available from URL: http://www.das-score.nl/ achieve improvements in function and QOL ap- www.das-score.nl/index.html [Accessed 2007 Oct 11] proaching those of people not affected by rheumatic 14. Den Broeder AA, Creemers MC, van Gestel AM, et al. Dose disease, benefiting both the patient and society. titration using the Disease Activity Score (DAS28) in rheuma￾While these benefits come at additional cost that toid arthritis patients treated with anti-TNF-alpha. Rheu￾matology (Oxford) 2002 Jun; 41 (6): 638-42 may be related to the high acquisition costs of these 15. Khanna D. Health-related quality of life: a primer with a focus drugs, other economic factors should also be consid- on scleroderma [online]. Available from URL: http:// www.sctc-online.org/pdfs/SCARV3N2.pdf [Accessed 2007 ered, including the overall impact of treatment on Oct 12] direct costs such as healthcare resource utilization, 16. Tsevat J, Weeks JC, Guadagnoli E, et al. Using health-related and indirect costs that may be related to productivity quality-of-life information: clinical encounters, clinical trials, and health policy. J Gen Intern Med 1994 Oct; 9 (10): 576-82 and improved QOL. 17. Guillemin F. Functional disability and quality-of-life assess￾ment in clinical practice. Rheumatology (Oxford) 2000 Jun; 39 Acknowledgements Suppl. 1: 17-23 18. Lubeck DP. Health-related quality of life measurements and The author is grateful to Health Science Communications studies in rheumatoid arthritis. Am J Manag Care 2002 Sep; 8 (9): 811-20 of New York for their editorial assistance and help with the 19. Lubeck DP. Patient-reported outcomes and their role in the electronic submission. assessment of rheumatoid arthritis. Pharmacoeconomics 2004; No sources of funding were used to assist in the prepara- 22 (2 Suppl. 1): 27-38 tion of this review. The author has no conflicts of interest that 20. Russell AS, Conner-Spady B, Mintz A, et al. The responsive- are directly relevant to the content of this review. ness of generic health status measures as assessed in patients with rheumatoid arthritis receiving infliximab. J Rheumatol 2003 May; 30 (5): 941-7 References 21. Coons SJ, Rao S, Keininger DL, et al. A comparative review of 1. Turesson C, O’Fallon WM, Crowson CS, et al. Occurrence of generic quality-of-life instruments. Pharmacoeconomics 2000 extraarticular disease manifestations is associated with excess Jan; 17 (1): 13-35 © 2008 Adis Data Information BV. All rights reserved. Pharmacoeconomics 2008; 26 (10)