A asma é considerada um problema de saúde pública mundial. É necessário expandir o conhecimento sobre seus custos associados em diferentes regiões. O principal objetivo foi estimar os custos do tratamento da asma em uma população de asmáticos com diferentes níveis de gravidade, sob tratamento ambulatorial especializado. Os objetivos secundários foram analisar as características clínicas e sócio-econômicas da população e o custo incremental da associação com a rinite e infecções respiratórias (IR). Asmáticos &#8805; 6 anos de idade com asma persistente foram incluídos consecutivamente de março de 2011 a setembro de 2012. Todos realizaram visitas clínicas de rotina com intervalos de 3-4 meses e 2 entrevistas com intervalos de 6 meses para coleta dados. Variáveis clínicas e dados primários sobre os custos da asma, rinite e infecções respiratórias (IR) foram coletados diretamente dos pacientes ou responsáveis (< 18 anos), sob uma perspectiva da sociedade. Os custos em reais foram convertidos em dólares usando a paridade do poder de compra em 2012 (US$ 1,00 = R$ 1,71). Cento e oito pacientes completaram o estudo, sendo 73,8% mulheres. A maioria (75,0%) reside no município do RJ, sendo que 60,1% destes moram longe da unidade de saúde. Rinite crônica estava presente em 83,3%, e mais da metade tinha sobrepeso ou obesidade, nos quais a prevalência de asma grave foi maior (p = 0,001). Metade ou mais dos trabalhadores e estudantes faltaram as suas atividades em decorrência da asma. A renda familiar mensal (RFM) média foi de US$ 915,90 (DP=879,12). O custo médio estimado da asma/rinite/IR foi de US$ 1.276,72 por paciente-ano (DP=764,14) e o custo médio específico da asma foi de US$ 1.140,94 (DP=760,87). Asmáticos obesos, graves ou não controlados tiveram maiores custos em comparação aos não obesos, moderados/leves e controlados (p <0,05 em todas as comparações). A população estudada tem nível sócio-econômico médio/baixo, alta prevalência de rinite crônica e de sobrepeso/obesidade. Maior peso e menor RFM foram mais frequentes entre os graves e não controlados, respectivamente. Asmáticos obesos, graves ou não controlados tiveram maiores custos. O custo incremental da rinite e IR foi de 12%. O custo médio da asma foi equivalente à metade do relatado na União Européia e nos Estados Unidos da América, e foi maior do que a média na região Ásia-Pacífico. Num cenário ideal, onde todos os asmáticos brasileiros recebessem tratamento no Sistema Único de Saúde de acordo com a Iniciativa Global para Asma, o custo total da asma seria equivalente a 3,4-4,5% e 0,4-0,6% do Produto Interno Bruto (PIB) da saúde e do PIB brasileiro, respectivamente. Estratégias de saúde pública com programas estruturados que facilitem o melhor controle da asma e estimulem a redução de peso poderão contribuir para reduzir os custos da doença, o que poderia tornar a oferta de tratamento medicamentoso gratuito para todos os asmáticos persistentes no SUS uma meta alcançável. Recomendamos estender este estudo de custo da asma para diferentes regiões do país. / Asthma is considered a health problem worldwide. It is necessary to expand our knowledge in different regions of the world, including its associated costs. The major aim was to estimate economic costs of asthma treatment in a cohort of persistent asthmatics with different severity levels under specialized ambulatory care. Secondary aims were to analyze the clinical and socioeconomic characteristics of this population and to estimate the incremental cost associated to rhinitis and respiratory infections. Patients &#8805; 6 years old with persistent asthma were consecutively included from March 2011 to September 2012. They made routine clinical visits with 3 to 4-month intervals and 2 interviews with 6-month intervals. Clinical variables and asthma, rhinitis and respiratory infections (RI) primary data on costs were collected directly from patients or their parents (patients under 18 years old), regarding the two 6-month prior periods in a societal perspective. Brazilian costs were converted into USD using the purchasing power parity in 2012 (US$ 1.00=R$ 1.71). One hundred and eight out of 117 subjects completed the study. 73.8% were women, 60.1% lived far from the health care unit. Chronic rhinitis was present in 83.3% and more than 50.0% were overweight or obese, in whom the prevalence of severe asthma was greater (p=0.001). 75% of the students and half of the workers had missed activity days because asthma. Mean monthly family income (MFI) was US$ 915.90 (SD=879.12). The estimated mean total cost of asthma, rhinitis and RI was US$ 1,276.72 per patient-year (SD=764.14) and the mean specific annual asthma cost was US$ 1,140.94 (SD=760.87) per patient. Obese, severe or uncontrolled asthmatics had greater costs compared to non-obese, mild/moderate and controlled ones, respectively (p<0.05 in all comparisons). The population had medium to low socio-economic status, a high prevalence of associated chronic rhinitis and overweight or obesity. High body weight and lower MFI were more frequent among patients with greater severity and worse control, respectively. Obese, severe or uncontrolled asthmatics had greater costs. Asthma had a great impact on absenteeism. The mean cost of asthma was equivalent to the half of that in European Union and United States of America and was greater than the mean of Asia-Pacific region. In an ideal scenario, where all asthmatics would be receiving GINA guided treatment in the Unified Health System (UHF), like ours, the total cost of asthma would be equivalent to 3.4 to 4.5% and 0.4 to 0.6% of Brazilian health gross domestic product (HGDP) and Brazilian GDP, respectively. Public health strategies with programs aiming get better control and stimulating weight reduction could contribute to lower cost of asthma, possibly making the offer of free asthma medication to all persistent asthmatics in UHF a more achievable task. We recommend to expand this study to other different regions.

Prevalence of obesity worldwide has increased rapidly in the last decade. In the Czech Republic, a similar trend has been observed. Every fifth adult has a problem with obesity, a fact which puts the Czech Republic among the countries with the highest obesity rates in European and global context. Obesity is a risk factor leading to a number of serious diseases. The growing prevalence of obesity is directly causing higher health care spending and also incurs costs indirectly, in terms of productivity losses. Present thesis is the first study in the Czech Republic, providing an estimate of both direct and indirect costs related to the obesity. Using a cost-of-illness method, the overall social costs of obesity in the Czech Republic for 2013 were estimated at 12.1 billion CZK which corresponds to 0.3% of GDP in the given year. Direct costs accounted for two thirds of this amount. The highest costs, attributable to the obesity, were inflicted by back pain diseases, arthritis, ischemic heart diseases and type 2 diabetes.

This diploma thesis describes the issue of rare diseases in terms of their essence and the situation in the Czech Republic nowadays. As a disease model was chosen cystic fibrosis. The main goal of this work is to quantify the cost of treatment of cystic fibrosis for three consecutive years and to analyse their structure in the cohorts of patients.

The aim of thesis is to identify and quantify the cost for therapy of colorectal cancer. The aim is to quantify the cost of individual treatments normally used in different stages of the disease and the total cost of treatment.

No description available.

<p><strong>Background and Objectives: </strong>There are methodological challenges with research in osteoporosis. The first is to predict the lifetime risk of hip fracture incorporating trends in the rates of hip fracture and mortality. The second is to identify optimum pharmacotherapy to reduce fractures in the absence of active-comparator trials. A third is to isolate the costs for incident and prevalent fractures. The objective of this thesis is to investigate these issues.</p> <p><strong> </strong><strong>Methods: </strong></p> <p>Project 1: From national administrative data, we estimated the lifetime risk of hip fracture for age 50 years to end of life using life tables.</p> <p>Project 2: A literature review identified randomized placebo-controlled trials with nine drugs for post-menopausal women to estimate odds ratios between drugs for fractures.</p> <p>Project 3: From provincial administrative data from Manitoba excess costs relative to matched controls were estimated for incident fractures, prevalent fractures and non-fracture osteoporosis. .</p> <p><strong>Results and Conclusions:</strong></p> <p>Project 1:<strong> </strong>For women and men, the crude lifetime risks of hip fracture was 12.1% and 4.6% respectively, and lower after incorporating trends, 8.9% and 6.7%. The risk is expected to continue to fall for both women and men.</p> <p>Project 2: Three drugs, zoledronic acid, teriparatide and denosumab, had the highest odds of reducing fractures and the largest effect sizes. Estimates were consistent between Bayesian and classical approaches.</p> <p>Project 3: All incident fracture types and most prevalent fractures had significant excess costs, and the results were robust to assessment of missing variances. Excluding prevalent fractures underestimates the cost of illness of fractures.</p> / Doctor of Philosophy (PhD)

Introdução: A compreensão do impacto da deficiência auditiva na população idosa é muito importante para o estabelecimento de ações preventivas e/ou reabilitadoras e, desse modo, tem sido alvo de muitas pesquisas. No entanto, não existe na literatura estudo que compare o impacto da deficiência auditiva em idosos institucionalizados e não institucionalizados com mesmo tipo e grau de perda auditiva bilateral. Objetivos: 1) caracterizar os idosos institucionalizados quanto às características sociodemográficas; 2) estimar a prevalência de deficiência auditiva referida em idosos institucionalizados, assim como fatores associados e causas atribuídas; 3) verificar se a percepção de restrição de participação difere entre idosos institucionalizados e não institucionalizados com mesmo tipo e grau de perda auditiva bilateral. 4) verificar se a percepção dos prejuízos decorrentes da perda auditiva difere quanto às variáveis sociodemográficas e condições de saúde (número de doenças referidas e sintomatologia depressiva). Metodologia: O estudo envolveu duas etapas. Na primeira, foram incluídos 110 idosos de seis instituições de longa permanência para idosos, filantrópicas, de Ribeirão Preto, com condições mentais e cognitivas favoráveis para compreender os objetivos do estudo e participar da entrevista. A entrevista constou de um roteiro com perguntas estruturadas para a obtenção de dados pessoais e sobre a audição. Para a investigação da deficiência auditiva referida, foram feitos os seguintes questionamentos: \"O(a) senhor(a) tem dificuldade para ouvir?\"; \"Precisa aumentar o volume da TV ou rádio para entender a notícia/ música?\"; \"Tem dificuldade para entender a conversa das pessoas?\". O idoso foi considerado com deficiência auditiva referida quando respondia afirmativamente para alguma dessas perguntas. A segunda parte envolveu a aplicação do Hearing Handicap Inventory for the Elderly (HHIE) em 38 idosos com mesmo tipo de perda auditiva que foi sensorioneural moderada bilateral, sendo 10 institucionalizados e 28 não institucionalizados. Para a análise estática dos dados, foram aplicados diferentes testes, como t de Student, Mann-Whitney, teste de postos sinalizados de Wilcoxon, Qui-Quadrado e Exato de Fisher. Resultados e Conclusões: 1) Os idosos institucionalizados eram predominantemente mulheres, de cor branca, com idades entre 70 e 89 anos, não longevos, solteiros, alfabetizados, com um até quatro anos de estudo, com tempo médio de institucionalização de 55,8 meses. 2) A prevalência de deficiência auditiva referida foi de 30% e associou-se significantemente com idade (p=0,0109), faixa etária (p=0,0182) e longevidade (p=0,0056). Envelhecimento foi a causa mais atribuída à deficiência auditiva referida. 3) Para ambos os grupos de idosos, prevaleceu a percepção severa da restrição de participação auditiva, sem diferença significativa entre os grupos (p=0,9813). 4) A percepção de restrição de participação nesses idosos apresentou associação com a sintomatologia depressiva (p=0,0272). / Introduction: Understanding the impact of hearing impairment in the elderly population is very important to establish preventive and/or rehabilitative actions. This issue has been studied by many researchers. However, there is no study in the literature comparing the impact of hearing impairment in institutionalized and noninstitutionalized elderly with similar type and degree of bilateral hearing loss. Aims: 1) characterize the institutionalized elderly with regard to sociodemographic characteristics; 2) estimate the prevalence of referred hearing loss, associated factors and attributed causes in institutionalized elderly; 3) verify if the hearing handicap differs between institutionalized and non-institutionalized elders with the same type and degree of bilateral hearing loss. 4) verify whether the hearing handicap differs as to sociodemographic variables and health condition (number of referred diseases and symptoms of depression). Methodology: The study involved two steps. In the first one, 110 elderly people from six long-stay institutions for elderly, philanthropic, from Ribeirão Preto, were included, with favorable mental and cognitive conditions to understand the aims of the study and to participate in the interview. The interview consisted of a script with a list of questions designed to obtain personal data and information about hearing. In order to investigate referred hearing loss, the following questions were asked: \"Do you have difficulty hearing?\"; \"Do you feel the need to turn up the TV or radio volume in order to better understand the news/listen to the music?\"; \"Do you have difficulty understanding the conversation with people?\". The elderly person was considered to have referred hearing loss when he/she answered yes to some of the aforementioned questions. The second part involved the application of the Hearing Handicap Inventory for the Elderly (HHIE) to 38 elderly people with similar type of hearing loss, 10 of whom were institutionalized and 28 non-institutionalized. For the static analysis of the data, different tests were applied, such as Student\'s t, Mann-Whitney, Wilcoxon, QuiSquare and Fisher Exact. Results and Conclusions: 1) institutionalized elderly were predominantly white-skinned, the majority of whom were between 70 and 89 years, with age under 80 years old, female, single, literate, with one up to four years of schooling and an average institutionalization time of 55.8 months. 2) The prevalence of referred hearing loss was of 30% and was significantly associated with age (p=0,0109), age range (p=0,0182) and longevity(p=0,0056). Aging was the most mentioned cause of referred hearing loss. 3) For both groups of elderly there was a prevalence of severe handicap, with no significant difference among the groups (p=0,9813). Hearing handicap in these elderly people showed an association with symptoms of depression (p=0,0272).

Introdução: A compreensão do impacto da deficiência auditiva na população idosa é muito importante para o estabelecimento de ações preventivas e/ou reabilitadoras e, desse modo, tem sido alvo de muitas pesquisas. No entanto, não existe na literatura estudo que compare o impacto da deficiência auditiva em idosos institucionalizados e não institucionalizados com mesmo tipo e grau de perda auditiva bilateral. Objetivos: 1) caracterizar os idosos institucionalizados quanto às características sociodemográficas; 2) estimar a prevalência de deficiência auditiva referida em idosos institucionalizados, assim como fatores associados e causas atribuídas; 3) verificar se a percepção de restrição de participação difere entre idosos institucionalizados e não institucionalizados com mesmo tipo e grau de perda auditiva bilateral. 4) verificar se a percepção dos prejuízos decorrentes da perda auditiva difere quanto às variáveis sociodemográficas e condições de saúde (número de doenças referidas e sintomatologia depressiva). Metodologia: O estudo envolveu duas etapas. Na primeira, foram incluídos 110 idosos de seis instituições de longa permanência para idosos, filantrópicas, de Ribeirão Preto, com condições mentais e cognitivas favoráveis para compreender os objetivos do estudo e participar da entrevista. A entrevista constou de um roteiro com perguntas estruturadas para a obtenção de dados pessoais e sobre a audição. Para a investigação da deficiência auditiva referida, foram feitos os seguintes questionamentos: \"O(a) senhor(a) tem dificuldade para ouvir?\"; \"Precisa aumentar o volume da TV ou rádio para entender a notícia/ música?\"; \"Tem dificuldade para entender a conversa das pessoas?\". O idoso foi considerado com deficiência auditiva referida quando respondia afirmativamente para alguma dessas perguntas. A segunda parte envolveu a aplicação do Hearing Handicap Inventory for the Elderly (HHIE) em 38 idosos com mesmo tipo de perda auditiva que foi sensorioneural moderada bilateral, sendo 10 institucionalizados e 28 não institucionalizados. Para a análise estática dos dados, foram aplicados diferentes testes, como t de Student, Mann-Whitney, teste de postos sinalizados de Wilcoxon, Qui-Quadrado e Exato de Fisher. Resultados e Conclusões: 1) Os idosos institucionalizados eram predominantemente mulheres, de cor branca, com idades entre 70 e 89 anos, não longevos, solteiros, alfabetizados, com um até quatro anos de estudo, com tempo médio de institucionalização de 55,8 meses. 2) A prevalência de deficiência auditiva referida foi de 30% e associou-se significantemente com idade (p=0,0109), faixa etária (p=0,0182) e longevidade (p=0,0056). Envelhecimento foi a causa mais atribuída à deficiência auditiva referida. 3) Para ambos os grupos de idosos, prevaleceu a percepção severa da restrição de participação auditiva, sem diferença significativa entre os grupos (p=0,9813). 4) A percepção de restrição de participação nesses idosos apresentou associação com a sintomatologia depressiva (p=0,0272). / Introduction: Understanding the impact of hearing impairment in the elderly population is very important to establish preventive and/or rehabilitative actions. This issue has been studied by many researchers. However, there is no study in the literature comparing the impact of hearing impairment in institutionalized and noninstitutionalized elderly with similar type and degree of bilateral hearing loss. Aims: 1) characterize the institutionalized elderly with regard to sociodemographic characteristics; 2) estimate the prevalence of referred hearing loss, associated factors and attributed causes in institutionalized elderly; 3) verify if the hearing handicap differs between institutionalized and non-institutionalized elders with the same type and degree of bilateral hearing loss. 4) verify whether the hearing handicap differs as to sociodemographic variables and health condition (number of referred diseases and symptoms of depression). Methodology: The study involved two steps. In the first one, 110 elderly people from six long-stay institutions for elderly, philanthropic, from Ribeirão Preto, were included, with favorable mental and cognitive conditions to understand the aims of the study and to participate in the interview. The interview consisted of a script with a list of questions designed to obtain personal data and information about hearing. In order to investigate referred hearing loss, the following questions were asked: \"Do you have difficulty hearing?\"; \"Do you feel the need to turn up the TV or radio volume in order to better understand the news/listen to the music?\"; \"Do you have difficulty understanding the conversation with people?\". The elderly person was considered to have referred hearing loss when he/she answered yes to some of the aforementioned questions. The second part involved the application of the Hearing Handicap Inventory for the Elderly (HHIE) to 38 elderly people with similar type of hearing loss, 10 of whom were institutionalized and 28 non-institutionalized. For the static analysis of the data, different tests were applied, such as Student\'s t, Mann-Whitney, Wilcoxon, QuiSquare and Fisher Exact. Results and Conclusions: 1) institutionalized elderly were predominantly white-skinned, the majority of whom were between 70 and 89 years, with age under 80 years old, female, single, literate, with one up to four years of schooling and an average institutionalization time of 55.8 months. 2) The prevalence of referred hearing loss was of 30% and was significantly associated with age (p=0,0109), age range (p=0,0182) and longevity(p=0,0056). Aging was the most mentioned cause of referred hearing loss. 3) For both groups of elderly there was a prevalence of severe handicap, with no significant difference among the groups (p=0,9813). Hearing handicap in these elderly people showed an association with symptoms of depression (p=0,0272).

Introdução: As morbidades e mortalidade relacionadas ao uso de medicamentos (MRM) representam um desafio para a saúde pública e são consequências da utilização não efetiva e insegura dos medicamentos. Estudos internacionais mostram como as MRM afetam pacientes internados no hospital e como podem ser evitadas na maioria dos casos. Entretanto, pouco é conhecido sobre as MRM na prática ambulatorial. Estas pesquisas têm abordado as consequências clínicas negativas para os usuários de medicamentos e sugerem que vultosas somas de recursos financeiros são utilizadas para manejar e resolver estas morbidades ao redor do mundo. Já no Brasil, o conhecimento sobre as MRM é escasso em ambas perspectivas e o seu impacto econômico é desconhecido. Objetivo: O propósito desta Tese foi obter uma estimativa sobre os gastos com morbidade e mortalidade associadas ao uso de medicamentos no Brasil, utilizando modelos farmacoeconômicos (teórico e empírico). Métodos: Foram considerados como morbidades relacionadas a medicamentos os novos problemas de saúde advindos da utilização de uma farmacoterapia (por exemplo, reações adversas, dependência a medicamentos e intoxicação por overdose) e as falhas terapêuticas (por exemplo, efeito insuficiente dos medicamentos e problemas de saúde não tratados). Foram conduzidos dois estudos utilizando abordagens distintas (bottom up e top down) na coleta de dados sobre custos. O primeiro estimou, por meio da análise do tipo microcosting, os custos para resolução de Morbidades Relacionadas a Medicamentos em casos identificados no serviço de emergência de um hospital universitário. Resultados: O custo médio para tratar cada um desses pacientes é de aproximadamente R$ 2.200. Reações adversas a medicamentos, falta de adesão à farmacoterapia e problemas resultantes da administração de doses incorretas foram as causas mais prevalentes das morbidades. No segundo estudo, um modelo do tipo cost-of-illness foi traduzido e adaptado para a realidade brasileira, e então um painel com especialistas (farmacêuticos e médicos) foi realizado para estimar a proporção de pacientes que experimentam uma MRM, a proporção de MRM evitáveis e as consequências clínicas resultantes desta morbidade. A partir disto, o custo das MRM para o sistema de saúde brasileiro foi modelado, baseado em estatísticas nacionais sobre o consumo de serviços de saúde. Os especialistas julgaram as morbidades relacionadas a medicamentos como um evento bastante frequente. De acordo com esta estimativa central, as MRM seriam responsáveis por um uso considerável de recursos, podendo chegar a 23% do orçamento público anual total destinado à saúde no Brasil. Para cada real gasto com medicamentos, pelo Ministério da Saúde no Brasil, cinco reais seriam gastos para resolver as MRM. Da mesma forma foi verificado que mais da metade dos casos seriam evitáveis. Conclusão: As MRM são, de fato, um problema de ordem econômica-orçamentária, clínica e humanística para os usuários de medicamentos e para o sistema de saúde brasileiro, e que é imperiosa a criação de políticas públicas e ações capazes de evitar os danos gerados pelo uso não racional de medicamentos, garantir a segurança dos pacientes, bem como uma melhor alocação de recursos em saúde. / Introduction: Drug related morbidities and mortality (DRM) is a challenge to public health due to the consequences of ineffective and unsafe medicines use. It is well known that the DRM are common among hospitalized patients, and are preventable to some extent, but little is known about DRM outside the hospital. In Brazil, the knowledge on the subject is scarce and its economic impact is unknown. However, international studies suggest that DRM result in considerable amounts of financial resources to manage and resolve these morbidities around the world and the negative clinical consequences for those who use medicines. Aim: In this thesis, the drug related morbidities include: new medical problems arising from the pharmacotherapy (adverse effects, addiction to drugs and intoxication by overdose) and therapeutic failure (e.g. insufficient drug effect and untreated health problems). Methods: Two studies were conducted using different methodologies. The first study was a cross-sectional study, based on a microcosting analysis, where patients admitted to a teaching hospital emergency were identified in order to determine the proportion of people seeking health services due to a DRM, and, consequently, to obtain the cost for manage these patients. Results: It was observed that 14.6% of patients visiting an emergency service, do so because of a DRM and the average cost to treat each of these patients is approximately R$ 2,000. Adverse drug reactions, lack of adherence to pharmacotherapy and problems resulting from the administration of incorrect doses were the most prevalent causes of morbidity. In the second study, a cost-of-illness model was translated to portuguese and adapted, and then a panel of experts (pharmacists and physicians) was conducted to estimate the proportion of patients experiencing DRM, the proportion of preventable DRM, and the negative outcomes resulting from this morbidity. From this, the DRM cost for the Brazilian Health System was modeled, based on national statistics on the consumption of health services. Experts have judged drug-related morbidities to be a fairly frequent event. According to central estimate, the DRM would be responsible for a considerable use of resources, being able to reach 23% of the total annual public health budget in Brazil. For each real (R$ 1,00) spending on medicines, by the Brazilian Ministry of Health, five reais (R$ 5,00) would be spent to manage the DRM. Likewise, in this study it was also verified that more than half of the cases would be avoidable. In the second, a panel of experts (pharmacists and physicians) was performed to estimate the proportion of patients experiencing an DRM, DRM preventable ratio and the clinical consequences of this morbidity. From this, the cost of DRM for the Brazilian health system was modeled, based on national statistics on the consumption of health services. Conclusion: Based on these and many other results presented in this thesis, it is concluded that the DRM are indeed, an economic, clinical and humanistic issue for those who use medicines and to the Brazilian health system, and that is overriding the establishment of public policies and actions to prevent the damage caused by the non-rational use of medicines to ensure patient safety and to the best allocation of health resources.

L’arthrose est la maladie articulaire la plus fréquente pouvant être responsable d’une perte d’autonomie et d’un handicap fonctionnel majeur. Du fait du vieillissement de la population et de la prévalence de l’obésité, le nombre de personnes ayant une arthrose des membres inférieurs va augmenter dans les années à venir et entrainer une explosion des dépenses de santé. La cohorte « Knee and Hip OsteoArthritis Long-term Assessment » (KHOALA) est une cohorte française multicentrique représentative de patients atteints d’arthrose symptomatique de hanche et/ou de genou.Les objectifs de ce projet étaient d’établir une revue de la littérature sur les conséquences économiques de l'arthrose de hanche et/ou du genou. Puis à partir de la cohorte KHOALA, nous avons décrit la consommation de soins ; identifié les facteurs associés aux trajectoires d'utilisation des ressources de santé et estimé les coûts annuels totaux. Enfin nous avons réalisé une analyse systématique de la littérature sur les analyses coût-efficacité des anti-arthrosiques d’action lente et de l’acide hyaluronique intra articulaire dans l’arthrose de genoux.La revue systématique a objectivé une hétérogénéité des couts totaux par patient (de 0,7 à 12 k€/an). Les données de KHOALA ont démontré que la majorité des patients consultait son médecin généraliste et une minorité de patients consultait un spécialiste. Le seul facteur clinique indépendant prédictif des consultations des professionnels de la santé était l'état de santé mentale. Le coût total annuel moyen par patient sur la période d'étude de 5 ans était de 2180 ± 5 305 €. En France, les coûts médians pourraient atteindre 2 milliards € / an (IQR 0,7–4,3). / Osteoarthritis is the most common joint disease that can be responsible for a loss of autonomy and a major functional disability. With the aging of the population and the prevalence of obesity, the number of people with lower limb osteoarthritis will increase in the coming years and lead to an explosion of health spending. The "Knee and Hip OsteoArthritis Long-term Assessment" cohort (KHOALA) is a representative French multicenter cohort of patients with symptomatic hip and / or knee osteoarthritis.The aims of this thesis were to provide an overview of the economic consequences of hip and knee osteoarthritis worldwide. Then from the KHOALA cohort, we described health care resources use in the KHOALA cohort, we identified factors associated with trajectories of healthcare use and we estimated the annual total costs. Finally, we conducted a systematic review of the literature on the cost effectiveness of intra-articular hyaluronic acid and disease-modifying osteoarthritis drugs used in the treatment of knee OA.The systematic review showed a heterogeneity of the total costs per patient (from 0.7 to 12 k € / year). KHOALA data showed that primary care physicians have a central role in osteoarthritis care, mental health state was the only independent predictive factor of healthcare professional consultations. The mean annual total cost per patient over 5 years was 2180 ± 5,305 €. In France, median annual total costs would be approximately 2 billion €/year (IQR 0.7-4.3).