Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Spondyloarthropathies (SpAs) are a group of chronic, inflammatory diseases that cause significant disability and diminished quality of life. Studies show that SpAs such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA) come with high costs to society, stemming from intensive health care use (direct costs) and work productivity loss (indirect costs). However, there are few data on long term costs among patients with early SpA symptoms, which can evolve to various forms of the disease. To improve patient care and minimize health care costs, there is a need to identify predictors of elevated costs among patients with different forms of SpAs, and to know how different treatment practices affect costs over time, as treatments may be cost effective if they reduce long term health care use and work disability. The DESIR cohort is a group of 708 patients in France who have early SpA symptoms, such that doctors are unsure which SpA will develop. This study will analyze data from the DESIR study as patients are followed over time to 1) estimate the cost of SpAs in the first two years of symptoms, 2) identify predictors of increased costs, and 3) determine the cost-effectiveness of optimal SpA management, i.e., the best available treatment defined by the European League Against Rheumatism (EULAR). Costs will be calculated from the societal perspective, describing costs by category (direct versus indirect costs), by payer type (public health insurance versus private), and the distribution of costs over time. The associations between costs and patient, disease, and treatment characteristics will be explored using multivariate regression analyses. The cost effectiveness of optimal SpA management will be estimated using EULAR guidelines and quality of life data from DESIR. The total costs and quality adjusted life years of both groups will be calculated and adjusted for confounders, and incremental cost effectiveness ratios will be calculated and defined.