Financial cost of osteoarthritis in France: The “COART” France study

doi:10.1016/j.jbspin.2005.01.011

Joint Bone Spine

Volume 72, Issue 6, December 2005, Pages 567-570

https://doi.org/10.1016/j.jbspin.2005.01.011 Get rights and content

Abstract

Objective. – Osteoarthritis is the most common musculoskeletal disease, with about 9–10 million patients in France including 4.6 million with symptoms. The objective of the COART France study is to evaluate the cost of osteoarthritis in France from the societal point of view and to compare the results to those obtained in 1993 using the same methodology.

Materials and methods. – The cost of osteoarthritis was evaluated using the macroeconomic approach. Direct costs were estimated from healthcare resource use (physician visits, drug prescriptions, and hospital admissions) and indirect costs from doctor-prescribed sick-leave durations.

Results. – Direct costs of osteoarthritis in 2002 exceeded 1.6 billion Euros, contributing about 1.7% of expenses of the French health insurance system, which covers all residents of France regardless of employment or documentation status. Hospital admissions were the greatest single contributor to direct costs, with more than 800 million Euros. Osteoarthritis led to 13 million physician visits, during which 570 million Euros worth of medications were prescribed. The 156% increase in direct medical costs compared to 1993 was chiefly related to an increase in the number of patients (+54%); the cost increase per patient was only 2.5% per year.

Conclusion. – Despite the large increase in the number of treated patients and the development of new costly medications, the rise in the cost of managing osteoarthritis seems well contained. The aging of the population, development of new technologies, and increasing patient expectations will probably govern the future economic impact of osteoarthritis, which remains a major public health burden.

Introduction

Osteoarthritis is the leading source of morbidity in industrialized countries [1]. Symptoms, when present, include pain and reduced motion range leading to partial or complete work incapacitation, difficulty with activities of daily living, and alterations in quality of life. Musculoskeletal diseases, most notable spinal and disk disorders, come second only to cardiovascular disease as a cause of disability [2]. The prevalence of osteoarthritis in France is about 17%, with 9–10 million patients [3], among whom about half experience symptoms. Every year, about 4.6 million patients see physicians for osteoarthritis-related symptoms [4]. Over 80% of patients with osteoarthritis are older than 50 years of age, and women contribute two-thirds of cases [1], [3], [5].

Treatment objectives in osteoarthritis include relieving pain, minimizing functional impairment and disability, and if possible slowing disease progression by inhibiting cartilage damage [6], [7], [8], [9], [10], [11]. A study published in 1993 [12] found that the direct and indirect cost of osteoarthritis in France was about 1 billion Euros per year. The objective of the COART France study reported here was to obtain recent data on the cost of osteoarthritis and to identify factors that influenced cost changes as compared to 1993.

Section snippets

Study design

The direct and indirect medical costs of osteoarthritis were evaluated using the most recent nationwide data on utilization of outpatient and inpatient healthcare resources and on physician-prescribed sick-leaves, from 2001 to 2003. To assess healthcare resource utilization according to the joints involved, osteoarthritis sites and patterns were identified according to the tenth revision of the International Classification of Diseases (ICD) (Table 1), in which M15-M19 indicate peripheral

Healthcare resource use

a) Over 13 million physician visits for osteoarthritis occurred, 91% with general practitioners and 8% with rheumatologists. The corresponding cost to the government health insurance program was 270 million Euros per year. Mean number of medications prescribed was 1.5 per patient.

b) Each year, physicians wrote 18 million orders for medications to treat osteoarthritis, including 7 million (41%) for analgesics, 3.5 million (21%) for symptomatic slow-acting drugs for osteoarthritis (Sy-SADOA), 1.8

Discussion

The results from the COART France show that the direct medical cost of osteoarthritis is about 1.6 billion Euros per year in France. Adding sick-leave benefits, which reflect the functional impairment often associated with osteoarthritis, indicates that the societal and economic burden is huge, similar to that created by coronary heart disease.

The increase in the cost of osteoarthritis management noted over the last decade can be ascribed in about equal proportion to the growing population of

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¹: Study on the “COûts de l'ARThrose”, or the costs engendered by Arthritis, in France, on the initiative of Laboratoires NEGMA-LERADS.

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Original articleFinancial cost of osteoarthritis in France: The “COART”1 France study

Abstract

Introduction

Section snippets

Study design

Healthcare resource use

Discussion

Medical management of osteoarthritis

Br. Med. J.

The prevalence and burden of osteoarthritis

Rheumatol.

EULAR recommendations 2003: an evidence-based approach to the management of knee osteoarthritis: report of a task force for the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT)

Ann. Rheum. Dis.

Recommendations for the medical management of osteoarthritis of the hip and knee

Arthritis Rheum.

Medical management of osteoarthritis

Br. Med. J.

Original article
Financial cost of osteoarthritis in France: The “COART”¹ France study