Economic Burden Of Controlled Gout, Uncontrolled Gout, And Gout Exacerbated By Common Comorbidities: Results From The 2012-2013 National Health And Wellness Survey

Gout is a urate crystal deposition disease caused by chronic high serum uric acid (sUA) levels (i.e., hyperuricemia), resulting in painful flares and tophi. Treatment guidelines recommend maintenance of sUA levels <6 mg/dL; however, sUA often remains elevated because of lack of, or inadequate response to therapy. Our goal was to understand the relationship between gout control and economic burden and to explore the impact of comorbidities. Data are from the combined 2012 and 2013 US National Health and Wellness Survey (NHWS), a representative, cross-sectional general health survey (2012, n=71,157; 2013, n=75,000) of which 3729 individuals self-reported a gout diagnosis (n=344 controlled [sUA ≤6 mg/dL and no flares in past year], n=2215 uncontrolled [sUA>6 and/or ≥1 flare], and n=1170 unknown). Estimated total cost was calculated by adding direct cost (e.g., resource use) and indirect cost (e.g., work productivity loss). Those with gout + comorbidities (e.g., cardiovascular disease [CVD]) and their relationship with total cost were also examined. Multivariable generalized linear models were used to control for demographic and health characteristics to assess unique burden of uncontrolled gout. Adjusted models indicate that those with controlled gout do not statistically differ from non-gout subjects. Those with uncontrolled gout reported significantly higher total annualized costs than non-gout subjects. Although uncontrolled gout had higher total cost than controlled gout, the difference was not significant. Similar patterns were observed for gout control and comorbidities. Those with uncontrolled gout + comorbidity (diabetes or CVD) reported higher total costs than those without gout or their respective comorbidity. There was no statistical difference for those with controlled gout + comorbidity versus those without gout or comorbidity. Uncontrolled gout results in higher total costs than for non-gout patients. Controlled gout patients have lesser burden—closer to non-gout subjects. Total cost for uncontrolled gout may be further exacerbated by comorbidities.