Review Article Open Access Andrade et al., Health Econ Outcome Res Open Access 2017, 3:1 DOI: 10.4172/2471-268X/1000126 Volume 3 • Issue 1 • 1000126 Health Economics & Outcome Research: Open Access H e a l t h E c o n o m i c s & O u t c o m e R e s e a r c h : O p e n A c c e s s ISSN: 2471-268X Health Econ Outcome Res, an open access journal ISSN: 2471-268X Keywords: Cost-of-illness; Cancer; Economic burden; Systematic review; Oncology Introduction According to a systematic review of studies in adults, the prevalence of Rheumatoid Arthritis (RA) is 0.2-1.1% in developed countries, is higher in women, and has a large geographical variation [1]. Te incidence of the disease varies, depending on country, from 0.1 to 0.5 patients per 1000 inhabitants [1]. RA is associated with frequent comorbid conditions, especially cardiovascular diseases, gastrointestinal disorders, infections, psychiatric disorders and, more infrequently, some malignancies [2]. Importantly, RA is associated with an excess mortality of over 40% compared with the general population [3,4]. Health-Related Quality of Life (HRQoL) is also lower in patients with RA than in those with other disorders. Tis was shown in a meta- analysis of 31 studies, involving 22,335 patients, that compared HRQoL [using the 36-item Short-Form Health Survey (SF-36)] in patients with RA with matched HRQoL data for patients with hypertension, type 2 diabetes, myocardial infarction, or depression [5]. RA also carries a signifcant economic burden. A large multinational study (involving 32 countries including Spain) in patients with RA aged <65 years who were still working at the onset of symptoms showed that 37% subsequently became work-disabled because of disease progression (median 9 years) [6]. Te total national annual cost of RA has been estimated at €45.3 billion in Europe and at €41.6 billion in the USA (2006 values); the total annual cost of RA per patient has been estimated at €13,463 in Europe and €21,069 in the USA.7 In Europe, medical costs and drugs accounted for 35% of the cost, and non- medical costs for 14% [7]. Tis review summarizes the published literature on the burden of RA in Spain in terms of frequency, comorbidity and mortality, impact on quality of life, and associated costs. Literature Search We searched PubMed and EMBASE from December 2000 to December 2014 using the following terms: [Rheumatoid Arthritis and (Spain or Espana) and (economic or economics or pharmacoeconomic or pharmacoeconomics or cost or costs or price or pricing or expenditure or burden or “Quality of life”)] or [Rheumatoid Arthritis and (Spain or Espana) and (incidence or prevalence)] or [Rheumatoid Arthritis and (Spain or Espana) and (anxiety or depression or “depressive illness” or mortality or suicide or worry or distress or psychosis or neurosis)]. Additionally, we searched the reference lists of those articles identifed by the original search and of those from selected reviews on the topic for further publications of interest. We focused on original articles and excluded articles related to the analysis of specifc pharmacologic interventions, cost-efectiveness studies, and studies only in abstract and/or poster form. Te literature search returned 15 articles [8-22], and the review of the reference lists of these articles and reviews on the topic provided three additional references [23-25], leading to a total of 18 publications that have been included in this review: prevalence and incidence (three publications), comorbidity and mortality (seven), quality of life (fve), and costs (three). *Corresponding author: Paula Andrade, Lilly Espana, Avenida de la Industria, 30, 28108 Alcobendas, Madrid, Spain, Tel: +34 916635334; Fax: +34916233316; E-mail: andrade_paula@lilly.com Received December 16, 2016; Accepted February 01, 2017; Published February 07, 2017 Citation: Andrade P, Sacristan JA, Rentero ML, Hammen V, Dilla T (2017) The Burden of Rheumatoid Arthritis in Spain. Health Econ Outcome Res Open Access 3: 126. doi: 10.4172/2471-268x/1000126 Copyright: © 2017 Andrade P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Introduction: Rheumatoid arthritis (RA) is a chronic infammatory disease with an estimated prevalence of 0.2- 1.1%. Fatigue, swelling and deformation of the joints are complications of RA that lead to physical dysfunction and a considerable economic burden. The objective of this review was to bring together and analyze the Spanish publications on the burden of RA in Spain in terms of frequency, associated comorbidities, impact on quality of life, and associated costs. Methods: A search was conducted in MEDLINE, EMBASE (2000 to 2014), and in the reference lists of previous reviews. We identifed 18 publications of interest in the Spanish setting. Results: After an analysis of the literature, we found that RA in Spain has a prevalence of 0.50% and an incidence of 0.08 to 0.20 cases/1000 person-years. The most common comorbidities associated with RA are dyslipidemia, hypertension, depression and diabetes. In addition, RA is associated with an excess mortality of 85% compared to the general population. With regard to quality of life, RA has a signifcant negative effect on its physical component. Economic studies showed that the annual cost per patient varies depending on the study (€3,600 to €11,707 in 2002). The largest component of RA annual cost is direct costs, representing 70-75% of the total. Conclusion: RA in Spain is associated with impaired quality of life, increased disability and costs, and increased mortality. Epidemiological data indicate that the frequency of RA in Spain is similar to that of other developed countries. The Burden of Rheumatoid Arthritis in Spain Paula Andrade 1 *, Jose A Sacristan 1 , Maria Luz Rentero 1 , Volker Hammen 2 and Tatiana Dilla 1 1 Lilly Espana, Avenida de la Industria, 28108 Alcobendas, Madrid, Spain 2 Lilly Deutschland GmbH, Werner-Reimers-Straße 2-4, 61352 Bad Homburg, Germany