DEPRESSION AND ANXIETY AS DETERMINANTS OF PATIENT-REPORTED OUTCOMES IN INFLAMMATORY ARTHRITIS: A SYSTEMATIC REVIEW WITH IMPLICATIONS FOR HEALTH ECONOMIC MODELING
Author(s)
Xiaoyu Zhang1, Yunrong Bai, BSc2, Sam Norton, PhD3, James Galloway, PhD3, Kang Wang, MSc4, Peizhe Yan, MSc5, Huajie Jin, PhD4.
1PhDstudent, King's College London, LONDON, United Kingdom, 2Peking University, Beijing, China, 3King's College London, LONDON, United Kingdom, 4King's College London, London, United Kingdom, 5King's Health Economics, King's College London, London, United Kingdom.
1PhDstudent, King's College London, LONDON, United Kingdom, 2Peking University, Beijing, China, 3King's College London, LONDON, United Kingdom, 4King's College London, London, United Kingdom, 5King's Health Economics, King's College London, London, United Kingdom.
OBJECTIVES: Depression and anxiety affect up to one-third of patients with inflammatory arthritis (IA) and substantially influence utility, health-related quality of life (HRQoL), and functional disability, all outcomes central to cost-effectiveness models. Yet their role as explicit structural inputs in economic models remains underspecified. This systematic review synthesised evidence on associations between depression and anxiety and patient-reported outcomes in IA, with direct application to health economic model parameterisation.
METHODS: Observational studies in adults with IA (RA, axSpA, PsA, early IA) reporting associations between depression and/or anxiety and utility, generic HRQoL, disease-specific QoL, or functional status were eligible. Risk of bias was assessed using design-specific tools (JBI checklists; QUIPS for prognostic studies). Findings were synthesised narratively, with prespecified selective meta-analyses considered for coherent subgroups.
RESULTS: Seventy IA-specific studies were included (45 RA, 16 AS/axSpA, 3 PsA). Risk of bias was low in 27 studies, moderate in 41, and high in 2. Across disease subtypes and outcome families, including EQ-5D, SF-36/SF-12, HAQ/HAQ-DI, ASQoL, and RAQoL, the direction of association was highly consistent: greater depression and anxiety burden was associated with lower utility, poorer HRQoL, and worse functional disability. Evidence was strongest in RA, with coherent support in AS/axSpA and more limited findings in PsA. The strongest subgroups for selective meta-analysis were RA-EQ-5D, RA-SF-36/SF-12, and AS/axSpA-ASQoL. Depression remained independently associated with utility and HRQoL after adjustment for disease activity, indicating an effect not wholly explained by inflammatory burden.
CONCLUSIONS: Depression and anxiety are consistent and clinically meaningful determinants of patient-reported outcomes in IA, justifying explicit representation as health-state variables rather than background covariates in economic models. This review provides structural justification and candidate utility and disutility inputs for DES models evaluating mental health screening in rheumatology, with the strongest parameterisation evidence from RA-EQ-5D and AS/axSpA-ASQoL subgroups. Selective meta-analysis in these subgroups is a high-priority next step.
METHODS: Observational studies in adults with IA (RA, axSpA, PsA, early IA) reporting associations between depression and/or anxiety and utility, generic HRQoL, disease-specific QoL, or functional status were eligible. Risk of bias was assessed using design-specific tools (JBI checklists; QUIPS for prognostic studies). Findings were synthesised narratively, with prespecified selective meta-analyses considered for coherent subgroups.
RESULTS: Seventy IA-specific studies were included (45 RA, 16 AS/axSpA, 3 PsA). Risk of bias was low in 27 studies, moderate in 41, and high in 2. Across disease subtypes and outcome families, including EQ-5D, SF-36/SF-12, HAQ/HAQ-DI, ASQoL, and RAQoL, the direction of association was highly consistent: greater depression and anxiety burden was associated with lower utility, poorer HRQoL, and worse functional disability. Evidence was strongest in RA, with coherent support in AS/axSpA and more limited findings in PsA. The strongest subgroups for selective meta-analysis were RA-EQ-5D, RA-SF-36/SF-12, and AS/axSpA-ASQoL. Depression remained independently associated with utility and HRQoL after adjustment for disease activity, indicating an effect not wholly explained by inflammatory burden.
CONCLUSIONS: Depression and anxiety are consistent and clinically meaningful determinants of patient-reported outcomes in IA, justifying explicit representation as health-state variables rather than background covariates in economic models. This review provides structural justification and candidate utility and disutility inputs for DES models evaluating mental health screening in rheumatology, with the strongest parameterisation evidence from RA-EQ-5D and AS/axSpA-ASQoL subgroups. Selective meta-analysis in these subgroups is a high-priority next step.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE660
Topic
Economic Evaluation, Patient-Centered Research
Disease
Mental Health (including addiction), Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)