OBJECTIVES: Over the past couple of decades, there has been major advances in the management of rheumatoid arthritis (RA). It is now recognised that early diagnosis and intensive treatment can limit disease progression and restore physical function in patients with RA. One of the major developments have been the introduction of disease-modifying antirheumatic drugs (DMARDs) and biolgoics. However, these drugs are expensive, and have transformed the composition of and the total cost of illness of RA. The objective of this study is to synthesise the knowledge about contemporary cost of illness (COI) studies and understand the full burden of patients with recent-onset and established RA.

METHODS: We performed a systematic review of all COI studies of RA, published after the year 2000. Multiple databases using relevant keywords and search filters were searched. We synthesised the data from all relevant studies through a narrative synthesis, with specific focus on the impact of the various settings and methodological approaches used to estimate costs in the studies.

RESULTS: There were substantial variations in patient case-mix, healthcare settings, and methodological approaches to estimating COI of RA. The majority of the studies adopted the prevalence-based approach from a societal perspective to estimate an annual cost per patient. Direct costs tended to increase over the past decade mainly because of the introduction of biologics. However, this rising drug costs reached a plateau around 2009 and was subsequently offset by a general reduction in hospitalisation and in productivity loss. Productivity loss was mostly estimated by the human capital approach, accounted for the largest part of total annual cost, (45%-70% of total costs in the Western society).

CONCLUSIONS: In the management of RA, early and intensive treatment may increase the short-term direct costs, but in the longer-term, this was associated with reduced hospitalisation and productivity loss in the society.