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Review

The indirect costs of ankylosing spondylitis: a systematic review and meta-analysis

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Abstract

The aim of this systematic review was to collect and summarize all current data on the indirect costs related to absenteeism and presenteeism associated with ankylosing spondylitis. The search was conducted using Medline, Embase and Centre for Reviews and Dissemination databases. All collected costs were recalculated to average annual cost per patient, expressed in 2013 prices USD using the consumer price index and purchasing power parity. Identified studies were then analyzed to assess their possible inclusion in the meta-analysis. We identified 32 records. The average annual indirect cost per patient varies among all the identified results from US$660.95 to 45,953.87. The mean annual indirect per patient equals US$6454.76. This systematic review summarizes current data related to indirect costs generated by ankylosing spondylitis; it revealed the great economic burden of the disease for society. We observed a great variety of the considered components of indirect costs and their definitions.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues
  • Ankylosing spondylitis is an inflammatory joint disease that causes inflammatory back pain, which is associated with spine destruction and functional impairment.

  • Rheumatic diseases cause great decrease in quality of life, which lead to difficulties related to the patient’s activity in the labor market in a form of both absenteeism and presenteeism and also causes a huge socioeconomic burden.

  • Small amount of identified studies and great variety of considered components on indirect costs, estimation approaches and methodologies reflects that this issue is not yet fully examined and causes that indirect costs data from different studies are difficult or just impossible to analyze.

  • There is a great need of further studies focused on indirect costs in ankylosing spondylitis to make it possible to include societal perspective into cost–effectiveness/utility analyses.

  • From all of identified records, only five reported indirect costs associated with presenteeism and three of them were conference abstracts.

  • Costs of lost productivity range from US$660.95 to US$45,953.87, which can be a major part of total costs. The mean annual indirect per patient equals US$6454.76 with 95% CI from US$5263.4036 to US$7646.12.

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