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.

中文翻译：

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类风湿关节炎的经济负担：生物时代文献系统回顾

背景 在过去的几十年里，类风湿性关节炎 (RA) 的治疗取得了快速进展。特别是，生物和靶向合成疾病缓解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。目的 绘制有关 RA 疾病成本的现有证据，随着治疗途径在生物时代的发展，并检查成本是如何测量和估计的，以便收集和适当解释可用数据。方法 对估计 RA 患者费用的研究进行系统评价。搜索了多个电子数据库以识别 2000 年至 2019 年间发表的研究。根据研究和人口特征对报告的总成本和成本构成进行了评估。Cochran-Armitage 检验用于确定随时间增加或减少的比例的统计显着趋势。结果 总共包括 72 项研究。药物成本影响了直接成本的主要组成部分（高达 87%），并且随着时间的推移呈增加趋势，尽管在统计上并不显着。住院费用的比例按时间顺序显示出统计学上的显着下降（p=0.044）。主要与缺勤和工作残疾相关的间接成本占总成本的 39% 至 86%。报告的间接成本对估算方法高度敏感。结论 住院费用的下降趋势按时间顺序表明直接费用的其他组成部分的费用发生了变化。间接成本仍占总成本的相当大比例，工作残疾是主要的成本组成部分。不包含或不适当衡量间接成本的经济分析将低估 RA 的全部经济影响。