Economic burden of rheumatoid arthritis: a systematic review of literature in biologic era

Abstract

BackgroundThe past decades have seen rapid advances in the treatment of rheumatoid arthritis (RA). In particular, the introduction of biologic and targeted synthetic disease-modifying antirheumatic drugs have improved clinical outcomes and reconfigured traditional RA cost compositions.ObjectivesTo map the existing evidence concerning cost of illness of RA, as the treatment pathway evolves in the biologic era, and examine how costs have been measured and estimated, in order to assemble and appropriately interpret available data.MethodsSystematic review of studies that estimated the costs of patients with RA. Multiple electronic databases were searched to identify studies published between 2000 and 2019. The reported total costs and cost components were evaluated according to the study and population characteristics. The Cochran-Armitage test was used to determine statistically significant trends in increasing or decreasing proportions over time.ResultsOverall, 72 studies were included. Drug costs compromised the main component (up to 87%) of direct costs with an increasing trajectory over time, although not statistically significant. The proportion of costs for hospitalisation showed a statistically significant decrease chronologically (p=0.044). Indirect costs, primarily associated with absenteeism and work disability accounted for 39% to 86% of total costs. The reported indirect costs are highly sensitive to the approach to estimation.ConclusionsA decreasing trend in inpatient costs chronologically suggested a cost shift in other components of direct costs. Indirect costs still contributed a considerable proportion of total costs, with work disability being the main cost component. Economic analyses that do not incorporate or appropriately measure indirect costs will underestimate the full economic impact of RA.

Immunomodulatory effects of berberine on the inflamed joint reveal new therapeutic targets for rheumatoid arthritis management

“…1,2 Moreover, biological DMARDs are significantly more expensive than other treatments. 12 As estimated by a comprehensive meta-analysis, the annual direct medical costs in the USA, for biological users, are approximately three times greater than those using any treatment regimen according. 13 Therefore, there is an urgent need to address adjuvant immunomodulatory treatments for the management of RA.…”

“…On the other hand, synthetic DMARDs and glucocorticoids possess disease‐modifying properties, but their serious side effects impede long‐term use 1,2 . Moreover, biological DMARDs are significantly more expensive than other treatments 12 . As estimated by a comprehensive meta‐analysis, the annual direct medical costs in the USA, for biological users, are approximately three times greater than those using any treatment regimen according 13 .…”

<p>Methotrexate (MTX) Plus Hydroxychloroquine versus MTX Plus Leflunomide in Patients with MTX-Resistant Active Rheumatoid Arthritis: A 2-Year Cohort Study in Real World</p>

“…Previous cost-effectiveness analyses on RA were mainly centered on bioDMARDs vs csDMARDs. [39][40][41][42] The comparison among the conventional combinations were limited, 43 especially the cost-effectiveness of MTX+HCQ over MTX+LEF. This study provided direct evidence that in China mainland, the ICER yielded by MTX+HCQ was $1,111.8 per QALY greater than MTX+LEF.…”

Preferential Provision of Medicines – Economic Problems and the Need for Reforming

“…According to studies carried out in Russia, on average, the proportion of patients receiving GEBD was 2.79%, the main share -30-36% of prescriptions of GEBD were in three centers, in three more -10-12%, in the restup to 5% [12]. Total annual health care costs for RA patients are gradually increasing, 3 times higher than the cost of treating patients without RA ($ 20.919 vs. $ 7.197), with the main cost factor being outpatient costs and direct costs, reaching 87% [13,14]. The state program Medicare already in 2013 in terms of insurance coverage of the costs of prescription drugs, practically reached the limit and with difficulty provided RA patients receiving GEBD.…”