Is symptom duration before DMARD therapy a determinant of direct and indirect costs in DMARD-naïve RA patients? A systematic review
Sahbudin, Ilfita Singh, Ruchir Trickey, Jeanette Baranskaya, Aliaksandra Tracy, Alexander Raza, Karim Filer, Andrew Jowett, Sue Boonen, Annelies
Sahbudin, Ilfita
Singh, Ruchir
Trickey, Jeanette
Baranskaya, Aliaksandra
Tracy, Alexander
Raza, Karim
Filer, Andrew
Jowett, Sue
Boonen, Annelies
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2023-04-13
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Abstract
Objective: Early treatment of RA improves clinical outcomes; however, the impact on health economic outcomes is unclear. This review sought to investigate the relationship between symptom/disease duration and resource utilization/costs and the responsiveness of costs following RA diagnosis.
Methods: A systematic search was performed on Pubmed, EMBASE, CINAHL and Medline. Studies were eligible if patients were DMARD-naïve and fulfilled 1987 ACR or 2010 ACR/EULAR RA classification criteria. Studies had to report symptom/disease duration and resource utilization or direct/indirect costs as health economic outcomes. The relationships between symptom/disease duration and costs were explored.
Results: Three hundred and fifty-seven records were identified in a systematic search; nine were eligible for analysis. The mean/median of symptom/disease duration in studies ranged between 25 days and 6 years. Annual direct costs of RA following diagnosis showed a U-shaped distribution in two studies. Longer symptom duration before starting a DMARD (>180 days) was associated with lower health-care utilization in the first year of RA diagnosis in one study. Annual direct and indirect costs 6 months before RA diagnosis were higher in patients with shorter symptom duration (<6 months) in one study. Given the clinical and methodological heterogeneities, the association between symptom/disease duration and costs after diagnosis was not computed.
Conclusion: The association between symptom/disease duration at the time of DMARD initiation and resource utilization/cost in patients with RA remains unclear. Health economic modelling with clearly defined symptom duration, resource utilization and long-term productivity is vital to address this evidence gap.
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Sahbudin I, Singh R, Trickey J, Baranskaya A, Tracy A, Raza K, Filer A, Jowett S, Boonen A. Is symptom duration before DMARD therapy a determinant of direct and indirect costs in DMARD-naïve RA patients? A systematic review. Rheumatol Adv Pract. 2023 Apr 13;7(2):rkad040. doi: 10.1093/rap/rkad04
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