Economic Burden and Cost-Effectiveness of Management of Non-Infectious Uveitis: A Systematic Review

To evaluate the economic burden and cost-effectiveness of interventions and management of non-infectious uveitis (NIU). A comprehensive search was conducted across Medline, Embase, and Scopus databases from inception to March 2023. Risk of bias assessments were conducted using the Joanna Briggs Institute critical appraisal tools. A total of 24 articles consisting of 16 economic burden studies (67%) and 9 cost-effectiveness or cost-utility studies (38%) met the inclusion criteria. Annual direct medical costs ranged from $16,428 to $134,135 USD 2023, with costs being 4.3 times higher for those with blindness compared to those without vision loss. Direct medical costs for corticosteroid, immunosuppressive, and biologic therapies were $19,497, $29.979, and $45,830, respectively. Indirect costs ranged from $806 to $57,170, with costs being 2.1 times higher for persistent NIU and 2.3 times higher for those with blindness. Annual medication and intervention costs ranged from $345 to $13,134, with prescription drug costs being 60% higher for blind patients compared to those with moderate vision loss. Overall, cost-effectiveness analyses show promise for treatments like adalimumab and certain implants, though the extent of economic benefit depends on price reductions and healthcare system variations. Varying parameters like willingness-to-pay (WTP) thresholds and input parameters further complicated comparability. NIU poses a significant economic impact, particularly in patients with blindness and those on advanced therapies. While evidence is growing in Western countries like the US and UK, further research in non-westernized countries is warranted for a comprehensive, global understanding of the disease’s economic burden.本研究旨在评估非感染性葡萄膜炎（non-infectious uveitis, NIU）的干预与管理措施的经济负担及成本效益。研究检索了Medline、Embase及Scopus数据库自建库至2023年3月的全部相关文献。采用乔安娜·布里格斯研究所（Joanna Briggs Institute）的批判性评价工具进行偏倚风险评估。最终共有24篇文献符合纳入标准，其中包含16项经济负担研究（占比67%）与9项成本效益或成本效用研究（占比38%）。2023年美元计价下，年度直接医疗成本区间为16428美元至134135美元，失明患者的直接医疗成本较无视力损失者高出4.3倍。糖皮质激素、免疫抑制剂及生物制剂治疗的直接医疗成本分别为19497美元、29979美元与45830美元。间接成本区间为806美元至57170美元，持续性非感染性葡萄膜炎患者的间接成本较其他患者高出2.1倍，失明患者则高出2.3倍。年度药物与干预成本区间为345美元至13134美元，失明患者的处方药成本较中度视力损失患者高出60%。总体而言，成本效益分析显示阿达木单抗（adalimumab）及部分植入物治疗具有应用前景，但经济获益的程度取决于价格降幅与医疗体系差异。支付意愿（willingness-to-pay, WTP）阈值及各类输入参数等变量进一步加大了研究间的可比性难度。非感染性葡萄膜炎会造成显著经济负担，尤其对于失明患者及接受进阶治疗的患者群体，尽管美国、英国等西方国家的相关证据日益丰富，但为全面、系统地了解该疾病的全球经济负担，仍需在非西方国家开展更多研究。