The economic burden of gout: A systematic review
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.
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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.
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