Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
Tri-Service General Hospital, Department of Pharmacy Practice, National Defense Medical Center, Taipei, Taiwan.
Ann Rheum Dis. 2020 Jun;79(6):771-777. doi: 10.1136/annrheumdis-2019-216243. Epub 2020 Apr 3.
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.
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.
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.
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.
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.
过去几十年，类风湿关节炎（RA）的治疗取得了快速进展。特别是生物制剂和靶向合成的疾病修饰抗风湿药物的引入，改善了临床结果，并重新配置了传统的 RA 成本构成。
绘制现有关于 RA 疾病经济负担的证据图谱，随着生物时代治疗途径的发展，检查成本是如何被衡量和估计的，以便汇总和适当解释现有数据。
对评估 RA 患者成本的研究进行系统回顾。通过多个电子数据库检索了 2000 年至 2019 年发表的研究。根据研究和人群特征评估报告的总费用和费用构成。Cochran-Armitage 检验用于确定随时间推移的比例是否呈统计学意义上的增加或减少趋势。
共有 72 项研究被纳入。药物成本构成直接成本的主要组成部分（高达 87%），尽管没有统计学意义，但呈上升趋势。住院费用的比例随时间呈统计学意义上的下降趋势（p=0.044）。间接成本主要与旷工和工作残疾有关，占总费用的 39%至 86%。报告的间接成本对估计方法非常敏感。
随时间推移住院费用呈下降趋势，表明直接成本的其他组成部分出现了成本转移。间接成本仍然占总费用的相当大比例，工作残疾是主要的成本组成部分。不纳入或适当衡量间接成本的经济分析将低估 RA 的全部经济影响。
