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Acceptability of less than perfect health states in rheumatoid arthritis: the patients’ perspective

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Abstract

Some health problems are considered by many individuals as a ‘normal’ part of ageing. Our aim was to investigate whether patients with rheumatoid arthritis (RA) consider different types and levels of health losses as acceptable beyond a certain age. A multicenter cross-sectional survey was performed involving RA patients at the initiation of the first biological therapy. The EQ-5D and the Health Assessment Questionnaire Disability Index (HAQ-DI) questionnaires were used to describe domain-specific health states. Patients were asked to indicate for each domain from what age and onward (between ages 30 and 80 years in 10 year intervals) they considered moderate and severe problems acceptable or alternatively never acceptable. Seventy-seven RA patients (females 86 %, mean age 50.3, disease duration 9.1 years) completed the questionnaire. Disease activity (DAS28), EQ-5D and HAQ-DI scores were mean 6.00 (SD 0.85), 0.35 (SD 0.36), 1.48 (SD 0.66), respectively. The majority of the patients considered age 70 and beyond as acceptable to have some health problems (EQ-5D: self-care 42 %, pain/discomfort 34 %, mobility 33 %, usual activities 33 %, anxiety/depression 27 %), whilst at ages 30 and 40 as not acceptable. Severe health problems were mostly (57–69 %) considered never acceptable, except the ‘Usual activities’ domain (acceptable from age 80 by 50.6 %). The great majority of the patients (77–96 %) were younger than what they indicated as the acceptability age limit. Similar results were found for the HAQ-DI. This small experimental study suggests that RA patients consider some health problems acceptable. This acceptability is age related and varies by health areas. Further larger studies are needed to explore explanatory variables and to compare with other diseases. Owing to the impact acceptability might have on RA patients’ self-evaluation of current health state and decision-making, the topic deserves methodological improvement and further investigation.

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Acknowledgments

The authors are grateful to the patients who participated in the study. The survey would not have been possible without the valuable work of the following colleagues: Fülöp A and Tandari M (Budapest); Bodnár N, Szamosi Sz, Szűcs G and Váncsa A (Debrecen); Abrudán K, Kovács H and Závada Zs (Gyula); Szanyó F (Győr); Böjte Gy, Eiben A and Sterba G (Kistarcsa); Fazekas K, Flórián Á and Lukács K (Miskolc); Encs E, Tisza A and Varjú T (Nyíregyháza); Balogh A and Hulló D (Szeged); Baksay B, Bíró J and Gácsi K (Szolnok); Náfrádi L (Szombathely); and Niedermayer D and Varjú C (Pécs). The survey was supported by an independent grant from the Centre for Public Affairs Studies Foundation and HTA Co. The work was supported by the European Union and the State of Hungary co-financed by the European Social Fund in the framework of TÁMOP-4.2.4.A/2-11/1-2012-0001 ‘National Excellence Program’ (Z.S., Debrecen), and the University of Debrecen, Faculty of Medicine Bridging Fund (Z.S., Debrecen). The proofreading of the manuscript was supported by the TÁMOP 4.2.2./B-10/1-2010-0023 project.

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Authors and Affiliations

  1. Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary

    Márta Péntek, Noémi Vártokné Hevér, Bálint Strbák, Petra Baji, Valentin Brodszky & László Gulácsi

  2. Department of Rheumatology, Flór Ferenc County Hospital, Semmelweis tér 1., 2143, Kistarcsa, Hungary

    Márta Péntek & Ágnes Edit Tóth

  3. Department of Rheumatology II, Polyclinic of the Hospital Brothers of St. John of God in Budapest, Frankel Leó út 54., 1023, Budapest, Hungary

    Bernadette Rojkovich

  4. Department of Rheumatology and Immunology, University of Pécs, Akác u. 1., 7632, Pecs, Hungary

    László Czirják

  5. Department of Rheumatology I, Polyclinic of the Hospital Brothers of St. John of God in Budapest, Frankel Leó út 54., 1023, Budapest, Hungary

    Pál Géher

  6. Department of Rheumatology, Kálmán Pándy Hospital, Semmelweis u. 1., 5700, Gyula, Hungary

    Péter Keszthelyi

  7. Department of Rheumatology, Hospital of Hungarian State Railways, Verseghy u. 6-8., 5000, Szolnok, Hungary

    Attila Kovács

  8. Department of Rheumatology, Faculty of Medicine, Albert Szent-György Health Centre, University of Szeged, Kálvária sgt. 57., 6725, Szeged, Hungary

    László Kovács

  9. Department of Rheumatology, András Jósa Hospital, Szent István út 68., 4400, Nyíregyháza, Hungary

    Zita Szabó

  10. Department of Rheumatology, Institute of Medicine, University of Debrecen Medical and Health Science Center, Nagyerdei krt 98., 4032, Debrecen, Hungary

    Zoltán Szekanecz

  11. Department of Rehabilitation, Semmelweis Teaching Hospital – Szent Ferenc Hospital Division, Csabai Kapu u. 42., 3529, Miskolc, Hungary

    László Tamási

  12. Department of Rheumatology, National Health Center, Military Hospital, Dózsa Görgy út 112., 1062, Budapest, Hungary

    Ilona Ujfalussy

Authors
  1. Márta Péntek
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  2. Bernadette Rojkovich
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  3. László Czirják
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  5. Péter Keszthelyi
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  6. Attila Kovács
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  7. László Kovács
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  8. Zita Szabó
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  9. Zoltán Szekanecz
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  10. László Tamási
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  11. Ágnes Edit Tóth
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  12. Ilona Ujfalussy
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  13. Noémi Vártokné Hevér
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  14. Bálint Strbák
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  15. Petra Baji
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  16. Valentin Brodszky
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  17. László Gulácsi
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Correspondence to Márta Péntek.

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Péntek, M., Rojkovich, B., Czirják, L. et al. Acceptability of less than perfect health states in rheumatoid arthritis: the patients’ perspective. Eur J Health Econ 15 (Suppl 1), 73–82 (2014). https://doi.org/10.1007/s10198-014-0596-2

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  • DOI: https://doi.org/10.1007/s10198-014-0596-2

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