The economic burden of gout: A systematic review

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Abstract

Objective

Gout is a painful and disabling joint disease that constitutes the most common inflammatory arthritis in the US. To clarify the economic impact of gout, we systematically reviewed the literature on the direct and indirect costs associated with this disease.

Methods

We conducted a literature search of MEDLINE, EMBASE, International Pharmaceutical Abstracts, NHS Economic Evaluation, and CINAHL databases to identify studies of gout and economics. We systematically reviewed published studies that met our inclusion criteria and extracted and summarized all relevant economic parameters. Reported costs were inflation-adjusted to 2013 US dollars (USD).

Results

A total of 15 studies met all eligibility criteria. Three controlled studies reported all-cause total direct costs based on specific populations (i.e., $4733, $16,925, and $18,362 per capita among employed, elderly, and treatment-refractory gout populations, respectively, and $2562, $10,590, and $7188 among corresponding non-gout patients). Two additional studies, although uncontrolled, allowed for estimation of total all-cause direct costs in unselected gout populations ($11,080 and $13,170). Gout-related costs ranged from $172 to $6179, depending on population characteristics. Six studies reported positive associations of direct costs with SUA level, gout attack frequency, or presence of tophi. Four studies reported on indirect costs, which were estimated to be as high as $4341 USD.

Conclusion

The available data suggest that gout patients incur substantially greater direct and indirect costs as compared with gout-free individuals among elderly and treatment-refractory gouty patients, whereas the costs are considerably less among younger, employed gouty patients. Further, direct costs increased with worsening disease characteristics.

Introduction

Gout is a common and excruciatingly painful inflammatory arthritis associated with hyperuricemia. The prevalence of gout has increased over the past few decades to 3.9% of US adults (8.3 million individuals) [1], which is further complicated by a high level of cardiovascular, metabolic, and renal comorbidities [2]. The pathogenesis of gout is well understood; high levels of circulating serum uric acid (SUA) lead to the acute and chronic manifestations of gout via the deposition of monosodium urate crystals in the joints and the soft tissues [3]. Reducing SUA levels effectively “cures” the disease [4], and guidelines including the American College of Rheumatology [5] and the European League Against Rheumatism [6] recommend lowering SUA levels to target levels (<6 mg/dL or <5 mg/dL), as well as reducing recurrent attacks, destructive arthropathy, renal disease, and comorbidity. However, gout management remains suboptimal with insufficient SUA lowering [7] and a high rate of recurrent attacks [8], [9].

The high prevalence of gout and suboptimal management suggest that its economic impact could potentially be substantial. Indeed, there is a growing body of literature on the costs associated with this disease. A review article estimated the economic burden among men to be $27 million (2003 USD) [10]. A more recent review of existing literature reported a revised estimate of the burden of gout to be over $6 billion annually for prevalent cases [11]. To synthesize contemporary evidence on the economic impact of gout, we systematically reviewed the literature on the direct and indirect costs associated with this disease.

Section snippets

Data sources and searches

We conducted a literature search of MEDLINE (01 Jan 1946–15 May 2014), EMBASE (01 Jan 1974–15 May 2014), International Pharmaceutical Abstracts (01 Jan 1970–15 May 2014), NHS Economic Evaluation (01 Jan 1995–15 May 2014), and the Cumulative Index to Nursing and Allied Health Literature (01 Jan 1982–15 May 2014) databases. Our search strategies used a combination of controlled terms, subject headings, and keywords to locate studies related to the themes of gout and economics/cost (Supplementary

Literature search results

We identified 1534 articles after the removal of duplicates (Fig.). Following title and abstract review, full-text articles were assessed and excluded for the following reasons: no exposure (i.e., no gout patient population), no outcome (i.e., no direct or indirect cost), incorrect study type (e.g., review article) [10], [11], and non-English language. Overall, 15 studies met all eligibility criteria and were included in the systematic review.

Study characteristics

Characteristics for the 15 studies included in the

Discussion

We aimed to systematically review the literature to date on the costs of gout patient care. Overall, the limited available data suggest that gout patients incurred substantially greater all-cause and gout-specific direct costs and indirect costs as compared with gout-free individuals among elderly and treatment-refractory gouty patients, whereas reported costs were considerably less among employed gouty patients. However, these cost estimates were derived from specific subgroup populations,

Conclusion

In conclusion, the available data suggest that gout patients incur substantially greater direct and indirect costs as compared with gout-free individuals, specifically among elderly and treatment-refractory gouty patients, whereas the costs were found to be considerably less among young, employed gouty patients. Furthermore, these direct costs increased with worsening disease characteristics (i.e., higher SUA levels, greater attack frequency, and tophaceous gout). Moreover, the care for

Author contributions

SKR and DG developed the search strategies and conducted the literature searches. SKR and LCB screened titles and abstracts for inclusion and extracted the data. SKR, LCB, MDV, and HKC were responsible for data analysis and interpretation. SKR drafted the manuscript. All authors contributed to critical review of the manuscript and have read and approved the final manuscript.

References (34)

  • D. Khanna et al.

    2012 American College of Rheumatology guidelines for management of gout. Part II: therapy and anti-inflammatory prophylaxis of acute gouty arthritis

    Arthritis Care Res

    (2012)
  • W. Zhang et al.

    EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

    Ann Rheum Dis

    (2006)
  • M.A. De Vera et al.

    Medication adherence in gout: a systematic review

    Arthritis Care Res

    (2014)
  • T. Neogi et al.

    Frequency and predictors of inappropriate management of recurrent gout attacks in a longitudinal study

    J Rheumatol

    (2006)
  • A. Larg et al.

    Cost-of-illness studies: a guide to critical evaluation

    Pharmacoeconomics

    (2011)
  • M.R. Gold et al.

    Cost-effectiveness in health and medicine

    (1996)
  • Segel JE, Cost-of-illness studies-a primer, RTI-UNC Center of Excellence in Health Promotion Economics. RTI...
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