The economic burden of gout: A systematic review.
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.


CONCLUSIONS
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.
Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Sharan K
SK
Rai
Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Psychology, York University, Toronto, Ontario, Canada.
Lindsay C
LC
Burns
Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Mary A
MA
De Vera
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Aliya
A
Haji
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Dean
D
Giustini
Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: Choi.Hyon@mgh.harvard.edu.
Hyon K
HK
Choi
D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006073:Gout / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs; D006801:Humans
Cost-of-illness; Direct cost; Economics; Gout; Health care costs; Indirect cost