Background/Purpose:   The prevalence of gout, an excruciating and disabling joint disease, has been increasing in recent decades such that it now constitutes the most common inflammatory arthritis in the US.  A high rate of uncontrolled disease and high comorbidity burden suggest that the economic impact of gout could potentially be substantial.  To clarify this impact, we systematically reviewed the literature on the productivity loss and healthcare costs associated with gout.

Methods:  We conducted a mapped search of MEDLINE, EMBASE, IPA, and CINAHL databases for articles published between Jan 1993 to Jun 2013 that reported either direct or indirect costs of gout, encompassing healthcare utilization and productivity loss, respectively. Our search strategy employed mapped subject headings terms together with keywords for unindexed terms relating to the themes of gout and cost.  Titles and abstracts were reviewed for preliminary inclusion criteria of: 1) full-text, original, published article; 2) gout patient population; 3) direct or indirect costs reported; 4) English language.  Non-human studies and case-reports/series were excluded.  Where possible, data were abstracted and tabulated on annual all-cause and gout-related direct and indirect costs per patient.

Results: Our search strategy yielded a total of 2,954 unique articles.  Of these, 11 studies reporting direct and indirect costs for gout met our inclusion criteria and were included for review.  Seven studies reported gout-specific data on direct costs (medical services + prescriptions), 5 on medical services, and 4 on indirect costs (work productivity loss).  US estimates of the annual direct costs per patient ranged from $3,985–$22,562 for all-cause costs and $192–$5,924 for gout-specific costs.  Annual per-patient medical services costs ranged from $3,122–$14,866 and corresponding indirect costs ranged from $915–$3,900 US.  Patient characteristics associated with increased costs included: 1) ≥ 3 flares per year; 2) serum uric acid levels ≥ 6 mg/dL; 3) presence of tophi (Table).

Conclusion: Overall, the economic burden of gout was found to be substantial, with direct healthcare costs comparable to chronic rheumatic conditions such as rheumatoid arthritis.  There was a paucity of data on indirect costs associated with gout, the population costs of gout (rather than patient subgroups), a lack of standardized cost reporting, and a lack of validated instruments for cost assessment in gout.  Characteristics associated with increased costs generally reflected poorly controlled disease and were largely modifiable.  As gout represents a metabolically-driven arthropathy that can be fully controlled with proper therapeutic approaches, substantial resources could be spared through by closing the gap between guideline recommendations and practice.