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Original Article
DOI: 10.1016/j.reumae.2021.04.001
Available online 7 May 2021
Economic impact of obstetric events on women of reproductive age living with psoriatic arthritis, rheumatoid arthritis, axial spondyloarthritis and psoriasis in Spain
Impacto económico asociado a eventos obstétricos en mujeres en edad fértil con artritis psoriásica, artritis reumatoide, espondiloartritis axial y psoriasis en España
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Nuria Martíneza, Olga Villarb, Onica Armijoa, María Castellanosc, Natalia Marin Huartea, María Marequed, Miguel Ángel Casadod, Julia Martínez-Barrioe,
Corresponding author
juliamartinezbarrio@gmail.com

Corresponding author.
a Hospital Universitario La Paz, Madrid, Spain
b Hospital Universitario 12 de Octubre, Madrid, Spain
c Hospital Universitario del Sureste, Madrid, Spain
d Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
e Hospital General Universitario Gregorio Marañón, Madrid, Spain
Received 06 May 2020. Accepted 16 September 2020
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Figures (2)
Tables (5)
Table 1. Healthcare resource consumption for the management of events during fertility and conception.
Table 2. Healthcare resource consumption for the management of events in pregnancy.
Table 3. Healthcare resource consumption for the management of postpartum events.
Table 4. Pharmacological costs associated with the management of events.
Table 5. Unit costs (€, 2019).
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Abstract
Objective

To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System.

Methods

A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€,2019) were obtained from national, local databases.

Results

During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3642 for a preconception consultation in patients with PsA, RA and axSpA and €4339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1214 for a miscarriage in the first trimester, €4419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5507 were estimated associated with admissions to neonatology of premature infants of <28, 28−32 and 33−37 weeks, respectively.

Conclusions

This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.

Keywords:
Cost-analysis
Rheumatic diseases
Obstetric events
Maternal-foetal complications
Spain
Resumen
Objetivo

Estimar el coste anual asociado a eventos obstétricos que pueden experimentar mujeres en edad fértil con enfermedades inflamatorias inmunomediadas, desde la perspectiva del Sistema Nacional de Salud.

Métodos

Se desarrolló un análisis de costes para estimar el impacto anual por paciente asociado a eventos obstétricos en mujeres en edad reproductiva con artritis psoriásica (APs), artritis reumatoide (AR), espondiloartritis axial (EspAax) y psoriasis (PsO). Se consideraron eventos durante la fertilidad, la concepción, el embarazo y el posparto. Todos los parámetros fueron validados y consensuados por un panel multidisciplinar de expertos. Los costes unitarios (€,2019) se obtuvieron de bases de datos nacionales.

Resultados

Durante la fertilidad y concepción, se estimó un coste anual/paciente de 229€ para una consulta preconcepcional en pacientes con PsO, de 3.642€ en pacientes con APs, AR y EspAax y de 4.339€ para reproducción asistida. En el embarazo, el coste anual/paciente fue de 1.214€ para un aborto espontáneo en el 1er trimestre, 4.419€ para un aborto tardío en el 2º trimestre, 11.260€ para preeclampsia, 3.188€ para crecimiento intrauterino retardado y 12.131€ para amenaza de parto prematuro. En el postparto, se estimó un coste anual/paciente de 120.364€, 44.709€ y 5.507€ para prematuridad de <28, 28-32 y 33-37 semanas, respectivamente.

Conclusiones

Este análisis facilita información sobre la carga económica de los eventos en mujeres en edad reproductiva con APs, AR, EspAax y PsO. Una adecuada planificación junto con la individualización del manejo, el tratamiento y la monitorización adicional pueden reducir el riesgo y la carga de estos eventos.

Palabras clave:
Análisis de costes
Enfermedades reumáticas
Eventos obstétricos
Complicaciones materno-fetales
España

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