Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Healthcare Utilization and Productivity at Home and Work Place in Tophaceous vs. Non-Tophaceous Gout.

Khanna3,  Puja, Persselin1,  Jay, Hays2,  Ron, Furst2,  Daniel, Paulus2,  Harold, Maranian2,  Paul, Khanna2,  Dinesh

Greater Los Angeles VA
UCLA
UCLA and Greater Los Angeles VA

Objective:

Gout is a painful inflammatory arthritis that causes debilitating acute attacks and is associated with increased resource utilization. Retrospective claims data has shown economic impact of gout on both direct and indirect medical costs including office visits, emergency room visits, medications, and time lost from work. However, there is lack of prospective data in a well-defined gout cohort. In addition, no study has reported the impact of gout on productivity. We assessed the impact of gout on health care utilization and productivity at home and work place.

Methods:

Patients with tophaceous and non-tophaceous gout were recruited at VA and University medical centers. Productivity was assessed using Work Productivity Survey (Osterhaus, J, Arthritis Research & Therapy 2009). Patients indicated whether or not they were employed outside of the home, how many days in last month they missed work (employment or household work) due to gout, how many days/month productivity was decreased 50% due to gout, and how much gout interfered with work/household chores (0–10 scale), days/month they missed family and social activities, and days/month they required outside help. Health care utilization was assessed using UCSD Health Care Utilization Questionnaire (HCU). HCU asked about resource utilization during past 3 months on office/ hospital visits, surgeries, medical supplies, prescription and OTC medications due to their ongoing medical conditions (not just gout).

Results:

Of 71 patients, 45 (63%) patients had non-tophaceous gout. There were no statistical differences in demographics between tophaceous and non-tophaceous gout. On average, patients were 68.2 years old, 96% were male, 70% were Caucasian. Patient with tophaceous gout had similar disease duration, serum uric acid and Charlson comorbidity index; patients with tophi had worse HAQ-DI score (1.1 vs. 0.7, p=0.06). Only 20% of patients were employed. Patients missed an average of 3.7 days of work at home or work place per month, had work or home productivity reduced by more than 50% in 3 days per month, had 3 days with reduced family and social activities, and had 1.4 days where they required outside help to do work at home. Tophaceous gout was associated with greater loss of productivity at home and work place compared to non-tophaceous gout (Table). Resource utilization was not significantly different between the 2 groups.

Patient CharacteristicsTotal Population (N=71)Non-Tophaceous (N=45)Tophaceous (N=26)
Age (years), mean (SD)68.2 (10.0)67.5 (10.1)68.7 (9.9)
Charisons Comorbidity index, mean (SD)3.0 (2.6)3.0 (2.7)13.1 (2.4)
Severity of Gout scale, 0–10 mean (SD)3.0 (2.9)2.1 (2.3)4.7 (3.2)
Productivity   
Employed, N (%)14 (19.7)8 (17.8)8 (23.1)
Days missed due to gout, mean (SD)3.7 (8.1)3.2 (7.5)4.5 (9.1)
Days with reduced productivity due to gout, mean (SD)3 (7.1)2.4 (6.1)4.2 (8.6)
Gout interfered (0–10), mean (SD)3.3 (3.6)2.8 (3.4)4.4 (3.7)*
Days with reduced family and social activities, mean (SD)3 (6.8)1.6 (3)5.6 (10.4)
Days requiring outside help due to gout, mean (SD)1.4 (5.3)0.4 (1.7)3.1 (8.4)
UCSD Health Care Utilization (in last 3 months), mean (SD)   
Health care professional visit5.1 (5.8)5.2 (6.8)4.8 (3.4)
Phone calls to healthcare professional2 (3.1)1.9 (3.5)2.1 (2.3)
Triage or urgent care0.7 (1)0.7 (1)0.7 (0.9)
Health care visit to home0.6 (2.6)0.8 (3.1)0.4 (1.4)
Hospital admissions3 (11.4)14 (14.2)1.3 (2.9)
Prescription medications8.7 (4.7)8.5 (4.8)9.1 (4.6)
Non-prescription medications2.4 (2.8)2.8 (3.3)1.6 (1.5)
*p<0.05 for comparison between tophaceous and non-tophaceous gout

Conclusions:

Tophaceous gout negatively impacts work place and home productivity. The lack of significant differences in utilization in patients with and without non-tophaceous gout is likely due to similar comorbidity profiles.

To cite this abstract, please use the following information:
Khanna, Puja, Persselin, Jay, Hays, Ron, Furst, Daniel, Paulus, Harold, Maranian, Paul, et al; Healthcare Utilization and Productivity at Home and Work Place in Tophaceous vs. Non-Tophaceous Gout. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :155
DOI: 10.1002/art.27924

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