Background/Purpose: Gout is a crystal deposition disease and the most prevalent inflammatory arthritis in the United States (US). Maintaining gout control has been associated with reduced healthcare resource utilization and healthcare costs, with uncontrolled gout (serum uric acid [sUA] >6 mg/dl or ≥1 flare in past year) incurring >1.3 times the costs compared to controlled gout (sUA <6 mg/dl and no flares in past year).¹ The long-term impacts of uncontrolled gout, including economic consequences, have not been well summarized. A systematic literature review was conducted to clarify the economic value of controlling gout with treatment in the US.

Methods: A search of published literature from Jan 2006 to Jan 2016 was conducted in PubMed, EMBASE, MEDLINE In-Process, the Cochrane Collaboration, and other non-indexed citations. Three independent researchers reviewed the results using predetermined inclusion and exclusion criteria. Preliminary inclusion criteria were: 1) gout disease focus; 2) reported disease burden or treatment outcomes; 3) English language. Non-human studies, opinion-based reviews, and case-reports were excluded.

Results: We identified 178 studies meeting eligibility criteria. All studies reporting longitudinal epidemiology data indicated an increased prevalence of gout over time, ranging from 1.1% in 1959–1962 to 3.7% in 2009–2010. Of the 178 studies, 13 were found in which primary analyses of healthcare costs in patients with gout were conducted (Table). Classification of gout in US-focused retrospective claims database analyses were largely based on an incident population, which underestimates the true economic burden. Cost estimates for gout treatment in the US range from $7.7 billion for gout-specific costs to ≥$20 billion for total costs. Overall, the data show a substantial cost of care associated with uncontrolled gout that increases with disease severity and comorbidities, such as end-stage renal disease.

Conclusion: In the US, uncontrolled gout results in a significant economic burden that is higher in patients with more severe disease. Uncontrolled gout is associated with higher economic costs than controlled gout; furthermore, controlled gout has been associated with lower healthcare costs and protection against comorbidities. This study was sponsored by AstraZeneca.

1.             Morlock R, et al. Value Health. 2015;18:A640-641.