2. DETERMINATION OF COST OF ILLNESS
Direct costs
Indirect costs
Intangible costs

3. Direct Costs Outpatients costs Drug Costs Hospitalisation costs
Physician and Health professional
Radiographs
MRI, CT scans
Endoscopies
Other tests
Drug Costs
DMARDs
Biologics
NSAIDs
GI medications and Analgesics
Hospitalisation costs

4. INDIRECT COSTS Loss of income from work
Work disability in % after
5 years
RA more likely to lose jobs or retire early than OA
Reduction in household income
15% unable to get work
3 - 4 x higher than direct costs
Underestimated because of predominance of women

5. INTANGIBLE COSTS PAIN PSYCHOLOGICAL
Depression, Coping, Anxiety, Cognitive changes
LIMITED ACTIVITIES
CHANGE IN APPEARANCE

6. ARTHRITIS IMPACT SURVEY (KEH, Durban)
35% Totally dependent on state support
Pensioners %
Disability grant 25%
Two thirds of patients who stopped working did so because of their arthritis

7. Disability Legislation
In 1990 President Bush signed into law the Americans with Disabilities Act to extend the application of civil rights legislation to persons denied access to employment, housing, education, transportation or leisure pursuits due to chronic diseases

8. Factors influencing work disability in RA
Employment factors
Nature of job, physical activity needed, degree of autonomy, work environment, transport to work
Employee factors
Age at onset of RA, marital status, education, motivation for work
Disease factors
Time since onset, level of disability, EMS, flare-ups
Other factors
Visits to GP, hospital clinic, surgery, rehabilitation

9. Vocational Rehabilitation
A process whereby those disadvantaged by illness or disability can be enabled to access, maintain or return to employment, or other useful occupation

10. Vocational Rehabilitation
The best way to maintain work is to communicate quickly with employer at disease flare-up
Encourage openness between patient and employer
Current employer more likely to facilitate continued working than a new employer
Return on costs between 2 – 10 fold

11. Remedies Referral to Work Assessment Unit
Health service ready to respond to worker’s urgent need
Physician assessment of the risk of job loss
Job modification
Transport
Self-employment
Intensive rehabilitation