Is symptom duration before DMARD therapy a determinant of direct and indirect costs in DMARD-naïve RA patients?

Objective: Early treatment of rheumatoid arthritis (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 utilisation/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 American College of Rheumatology (ACR) or 2010 ACR/European Alliance of Associations for Rheumatology (EULAR) RA classification criteria. Studies had to report symptom/disease duration and resource utilisation or direct/indirect costs as health economic outcomes. The relationships between symptom/disease duration and costs were explored.

Results: 357 records were identified in systematic search; nine were eligible for analysis. Mean/median of symptom/disease duration in studies ranged between 25 days to 6 years. Annual direct costs of RA following diagnosis showed a U-shaped distribution in two studies. Longer symptom duration before starting DMARD (>180 days) was associated with lower health care utilisation in the first year of RA diagnosis in one study. Annual direct and indirect costs six months before RA diagnosis were higher in patients with shorter symptom duration (

Conclusion: The association between symptom/disease duration at the time of DMARD initiation and resource utilisation/cost in patients with RA remains unclear. Health economic modelling with clearly defined symptom duration, resource utilisation and long-term productivity is vital to address this evidence gap.