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Subjective health expectations at biological therapy initiation: a survey of rheumatoid arthritis patients and rheumatologists

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Abstract

Subjective health expectations of patients with rheumatoid arthritis (RA) and rheumatologists remain understudied. We measured subjective expectations regarding treatment effects of biologicals as well as future length and quality of life. Moreover, we compared expectations regarding treatment effects to actual treatment effects. We recruited a sample of Hungarian RA patients initiating treatment with biologicals. Expectations regarding treatment effects and future health were obtained through a written questionnaire from patients and physicians, including functional impairment (HAQ-DI), health status (EQ-5D) and disease activity (DAS28). After three months, actual treatment effects were obtained. Ninety-two RA patients (females N = 81, 88 %) with mean age of 51 (SD 12) and disease duration of 9 (SD 8) years with high average disease activity (DAS28: 6.1) were included. Patients expected significant and large health improvement within three months with mean changes on the HAQ-DI of −0.8 and on the EQ-5D of +0.4. Rheumatologists’ estimates were similar, and they expected significant decrease of 2.3 on the DAS28. Actual scores after three months were obtained for 77 patients. The measured scores were significantly lower than expected scores for the HAQ-DI and EQ-5D. Rheumatologists’ expectations for the DAS28 score were not significantly different from measured scores. Patients’ average expectations regarding quality of life scores for ages 60, 70, 80 and 90 were 0.44, 0.24, 0.06 and −0.02, respectively. Our results suggest that both RA patients and rheumatologists expect quick and significant health improvements from biological drugs and tend to overestimate actual short term treatment effects. Nonetheless, RA patients expect a sharp deterioration of future health.

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Acknowledgments

Authors are grateful to the patients who participated in the survey and the following colleagues for assisting with the local data collection: Angéla Fülöp, Pál Géher, Ilona Ujfalussy and Magdolna Tandari (Budapest); Zoltán Szekanecz, Nóra Bodnár, Gabriella Szűcs, Szilvia Szamosi and Andrea Váncsa (Debrecen); Péter Keszthelyi, Hajnalka Kovács, Klára Abrudán and Zsuzsa Závada (Gyula); Ferenc Szanyó (Győr); Ágnes Edit Tóth, Gyöngyi Böjte, Annamária Eiben and Gréta Sterba (Kistarcsa); László Tamási, Katalin Fazekas, Ágnes Flórián and Katalin Lukács (Miskolc); Tibor Varjú, Zita Szabó, Erzsébet Encs and Andrea Tisza (Nyíregyháza); László Kovács, Attila Balogh and Daniella Hulló (Szeged); Attila Kovács, Beáta Baksay, Judit Bíró and Katalin Gácsi (Szolnok); Lilla Náfrádi (Szombathely); László Czirják, Dóra Niedermayer and Cecília Varjú (Pécs). The survey was supported by an independent grant from the Centre for Public Affairs Studies Foundation and HTA Co.

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Authors and Affiliations

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

    Márta Péntek, László Gulácsi & Valentin Brodszky

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

    Márta Péntek

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

    Bernadette Rojkovich

  4. Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    Job van Exel & Werner B. F. Brouwer

Authors
  1. Márta Péntek
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  2. László Gulácsi
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  3. Bernadette Rojkovich
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  4. Valentin Brodszky
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  5. Job van Exel
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  6. Werner B. F. Brouwer
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Corresponding author

Correspondence to Márta Péntek.

Appendix

Appendix

Questionnaire used in the survey: expected health problems at ages 60, 70, 80 and 90 were asked applying the statements of the EQ-5D.

I think at age 60 I will have… (Please mark your response)

a.

No

Some

Major

Problems with walking about

b.

No

Some

Major

Problems with washing or dressing

c.

No

Some

Major

Problems with performing usual activities

d.

No

Some

Severe

Pain or discomfort

e.

No

Some

Severe

Anxiety or depression

  1. Ages 70, 80 and 90 were asked in a same construct

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Péntek, M., Gulácsi, L., Rojkovich, B. et al. Subjective health expectations at biological therapy initiation: a survey of rheumatoid arthritis patients and rheumatologists. Eur J Health Econ 15 (Suppl 1), 83–92 (2014). https://doi.org/10.1007/s10198-014-0597-1

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  • DOI: https://doi.org/10.1007/s10198-014-0597-1

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