Abstract
The economic burden of rheumatoid arthritis (RA) on society is high. Disease-modifying antirheumatic drugs (DMARDs) are the cornerstone of therapy. Biological DMARDs are reported to prevent disability and improve quality of life, thus reducing indirect RA costs. We systematically reviewed studies on the relationship between RA and indirect costs comparing biological treatment with standard care. Studies, economic analyses, and systematic reviews published until October 2018 through a MEDLINE search were included. A total of 153 non-duplicate citations were identified, 92 (60%) were excluded as they did not meet pre-defined inclusion criteria. Sixty-one articles were included, 17 of them (28%) were reviews. After full-text review, 28 articles were included, 11 of them were reviews. Costs associated with productivity loss are substantial; in several cases, they may represent over 50% of the total. The most common method of estimation is the Human Capital method. However, certain heterogeneity is observed in the method of estimating, as well as in the resultant figures. Data from included trials indicate that biological therapy is associated with improved labor force participation despite an illness, in which the natural course of disease is defined by progressive work impairment. Use of biological DMARDs may lead to significant indirect cost benefits to society.
Highlights
Rheumatoid arthritis (RA) is a progressive, chronic autoimmune disease that carries a significant global burden and affects economic activity [1,2]
Search results were screened in title relevance and full-text copies were retrieved if a publication was an article, which fulfilled the following criteria: (i) subjects at or over the age of 18, with a diagnosis of RA, (ii) a comparison of any type of biological therapy with any kind of treatment was performed, (iii) a measure of productivity loss was a study outcome, (iv) or the article was a narrative or systematic review of such studies, and (v) it was in English language
For the studies fulfilling the criteria of our review we provide an overview of design, patient population, and comparator (Table 1), and outcome measures for indirect costs with respective monetary gains associated with improved absenteeism (Tables 1 and 2) and presenteeism (Tables 1 and 3)
Summary
Rheumatoid arthritis (RA) is a progressive, chronic autoimmune disease that carries a significant global burden and affects economic activity [1,2]. Close to a third of patients may be permanently work disabled within the first three years of disease, which leads to both societal and individual costs [6]. An estimate of the annual economic burden of RA in the United States (US) puts the societal impact at $19.3 billion (in 2005), with 56% ($10.9 billion) due to indirect costs [8]. With increased understanding of pathogenesis, novel therapies are emerging, many are still limited to experimental settings, and conventional synthetic disease modifying anti-rheumatic drugs along with biological agents remain the mainstay of therapy [11].
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