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Economic burden of rheumatoid arthritis: a systematic review of literature in biologic era
  1. Ping-Hsuan Hsieh1,2,
  2. Olivia Wu1,
  3. Claudia Geue1,
  4. Emma McIntosh1,
  5. Iain B McInnes3,
  6. Stefan Siebert3
  1. 1 Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2 Tri-Service General Hospital, Department of Pharmacy Practice, National Defense Medical Center, Taipei, Taiwan
  3. 3 Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  1. Correspondence to Ping-Hsuan Hsieh, Health Economics and Health Technology Assessment, University of Glasgow Institute of Health and Wellbeing, Glasgow G12 8RZ, UK; p.hsieh.1{at}


Background The 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.

Objectives To 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.

Methods Systematic 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.

Results Overall, 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.

Conclusions A 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.

  • rheumatoid arthritis
  • economic evaluations
  • DMARDs (biologic)

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  • Handling editor Josef S Smolen

  • Twitter @StefanSiebert1

  • Contributors PHH, OW, CG and EM helped in the study concept and design. OW, CG and EM performed validation of data extraction. PHH helped in the first draft of the manuscript. Critical revisions of the manuscript for important intellectual content was performed by OW, CG, EM, SS and IM. All authors have full access to all of the data in the study, take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding PHH is funded by Tri Service General Hospital, Taiwan through a PhD scholarship.

  • Competing interests OW has received consultancy fees from Bayer, Lupin and Takeda outside the submitted work. IM has received honoraria and/or research funding from Abbvie, BMS, Janssen, UCB, Pfizer, Lilly and Gilead. SS has received grant/research support from BMS, Boehringer Ingelheim, Celgene, GSK, Janssen, Novartis, Pfizer, UCB, consultancy, speaking fees or honoraria from AbbVie, Boehringer Ingelheim, Celgene, Janssen, Novartis, UCB.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.