Presentation (CTI)

OBJECTIVES: Thyroid eye disease (TED) is an autoimmune disorder associated with significant quality-of-life impairment. Existing burden studies have primarily focused on clinical outcomes with limited attention to economic burden. This systematic literature review synthesizes current evidence on the economic burden of TED, including indirect costs, and identifies evidence gaps for future research.
METHODS: Following PRISMA guidelines, a systematic literature search was conducted in PubMed, Embase, and the Cochrane Library to March 2026. Search terms included keywords for TED, Graves’orbitopathy, economics, and cost of illness. Studies were selected based on predefined eligibility criteria, and two independent reviewers performed study selection using Covidence. Included studies were qualitatively synthesized using a structured form.
RESULTS: Of 434 studies identified, seven (five articles and two conference posters) from Europe, North America, and the Middle East were ultimately included. Notably, four studies adopted a societal perspective, highlighting the significant burden of indirect costs. TED was associated with a seven-fold higher risk of sick leave compared to other thyroid diseases and a lower probability of returning to work. National annual indirect costs in Germany reached USD 3.4 billion, and indirect costs accounted for approximately 70% of total costs in moderate-to-severe TED in Middle Eastern studies. Direct medical costs escalated with disease severity; in Germany, sight-threatening TED had about four-fold higher annual medical costs than mild TED, with total national direct costs of USD 200 million. Middle Eastern per-patient annual direct costs ranged from USD 2,500 to 30,000 across severity levels. Treatment cost was identified as a major concern in North America (37.1%).
CONCLUSIONS: TED imposes a substantial indirect economic burden, including increased risks of sick leave and permanent work disability, underscoring the importance of a societal perspective. However, evidence remains limited, particularly in East and Southeast Asian countries. Further economic burden studies from a societal perspective are warranted in these regions.