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Australian Journal of Pharmacy : April 2005
economics health economics Pharmacy Guild of Australia, director, health economics, Dr Michael Tatchell RTHRITIS is the major cause of disability and pain in Australia. In 2004 the disease affected 3.4 million (16.7 per cent of the population) and is predicted to increase in number and prevalence to 4.6 million (or 20 per cent of the population) by 2020. This is one of the main findings of a recent Access Economics’ Report,1 tis Australia. undertaken for Arthri- It is also clear that arthritis is not a dis- ease that afflicts only the elderly—the report finds that 60 per cent of the popu- lation suffering from arthritis are of work- ing age. The report warns that failure to take this disease seriously will have major eco- nomic implications for employers and the welfare system. The scope of the problem Arthritis has for some time been recog- nised as one of the most significant health problems. It is included among the Gov- ernment’s list of top national health pri- orities. Osteoarthritis, its most common form, affects one in 10 Australians and, together with four other forms—rheumatoid arthritis, fibromyalgia, systemic lupus ery- thematosus and gout—accounts for 90 per cent of all cases. In terms of numbers and prevalence, Access Economics finds that: • in 2004, 18.4 per cent of women had arthritis and 15.1 per cent of men; • 54 per cent of the population aged 75 or older had arthritis; • 60 per cent of all people with arthritis were of working age (15–64 years); • prevalence of osteoarthritis will increase from 7.8 per cent (1.6 million persons) to 9.8 per cent (2.3 million persons) by 2020; • prevalence of rheumatoid arthritis will increase from 2.5 per cent (0.5 million persons) to 3.0 per cent (0.7 million persons) by 2020; • prevalence of arthritis is rapidly The high cost of arthritis A approaching that of cardiovascular dis- ease; • the cost to the healthcare system of treating arthritis is greater than other national health priority areas such as diabetes and asthma; and • the disability burden of arthritis is equal to that of dementia and second only to depression. The cost of arthritis Access Economics classifies the costs of arthritis under various headings—direct allocated health system costs, unallocated health costs, indirect costs and the costs of suffering and premature death. Taken together these costs totalled $19.25bn in 2004. Direct allocated health system costs, which include inpatient hospital costs, aged care costs, medical and pharmaceu- tical costs, and research totalled $3bn in 2004. Of this, inpatient costs were about one-third of the total, outpatient costs a further 10 per cent, and aged care costs and pharmaceuticals were about 14 per cent each. Unallocated health system costs, which include spending on capital items, com- munity health, public health programs, administration, aids and appliances amounted to a further $486m. The indirect costs of arthritis, which include lost earnings, the losses from rais- ing additional taxation, the cost of paid carers, travel costs and equipment and modifications related to the illness amounted to $7.7bn in 2004. Taken together with the health system costs, these ‘financial costs’ totalled $11.2bn in 2004, or 1.4 per cent of GDP. This is equivalent to $560 per Australian and $3,300 for every person with arthritis in 2004. Most significant of all, however, is the cost of suffering and premature death associated with arthritis. Access Econom- ics estimates this cost at more than $8bn in 2004. 274 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 APRIL 2005 What can be done? The key to reducing the prevalence and severity of the disease lies in prevention, early diagnosis and cost effective treat- ment. The report finds, for example, that if an intervention in 2005 enabled arthri- tis onset to be delayed by 10 years, age- specific incidence rates would be reduced such that, by 2020, prevalence would be 11.1 per cent less than otherwise forecast —that’s 517,000 fewer cases. Access Economics identifies a number of cost effective treatments for arthritis including surgical and pharmaceutical interventions, as well as weight loss and education programs. Surgical interventions include total hip arthroplasty and endoscopic carpel tun- nel release. High on the list of cost effec- tive pharmaceutical interventions is the combined step-down regime of pred- nisone, methotrexate and sulphasalazine for patients with early rheumatoid arthri- tis. Other less cost effective treatments include aquatic classes for patients with osteoarthritis. Access concludes by stating ‘arthritis is a highly prevalent and costly disease, nec- essarily a national health priority area due to the extent of its prevalence and socio- economic impacts. Cost-effective inter- ventions and continued research and development to delay the onset of osteoarthritis in particular offer potential for substantial reductions in the future projected costs and burden of disease’. Arthritis Australia describes arthritis as a ‘disease giant’ and believes millions of dollars could be saved ‘if this issue is taken seriously’. From pharmacy’s point of view it is important to know and stress that phar- maceutical treatments for arthritis are among the more cost-effective interven- tions around. 1. Access Economics, Arthritis—the bottom line, the economic impact of arthritis in Australia, Janu- ary 2005. ¦