THU0411 CLINICAL, ECONOMIC, AND HUMANISTIC BURDEN ASSOCIATED WITH DELAYED DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW
Authors: Esther Yi, Amit Ahuja, Tanvi Rajput, Aneesh George, Yujin Park
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Delayed diagnosis in patients with axial spondyloarthritis (AxSpA) has been shown to negatively impact disease prognosis and contributes to worse economic and quality of life outcomes; however, there is limited evidence available regarding the association of delayed diagnosis of AxSpA with the comprehensive burden of disease. <h3>Objectives</h3> To identify and summarize current published literature evaluating the clinical, economic, and humanistic burden associated with delayed diagnosis in patients with AxSpA. <h3>Methods</h3> This systematic literature review was conducted and reported according to the PRISMA guidelines (Figure 1).<sup>1</sup> Publications were retrieved from the MEDLINE<sup>®</sup> (including MEDLINE<sup>®</sup>In-Process) and Embase<sup>®</sup> databases. English-language publications of original research articles (up to July 12, 2018) and conference abstracts (2014 to 2018) reporting studies of delayed diagnosis of adult patients with AxSpA associated with clinical, economic, or humanistic burden were eligible for inclusion. Abstracts from all records retrieved from the literature search were screened for eligibility by two independent reviewers (first-level screening); discrepancies between reviewers were resolved by a third independent reviewer. Citations that did not match the eligibility criteria and duplicates of citations were excluded at the abstract screening stage. Full-text publications underwent second-level screening as described for first-level screening. Data were extracted from all records that met the eligibility criteria after second-level screening. <h3>Results</h3> Of the 1391 publications retrieved, 21 studies from 13 countries (Argentina, Australia, China, Egypt, Korea, India, Iran, Ireland, Israel, Italy, Morocco, Turkey, and the United Kingdom) were included (Figure 1); 15 reported clinical burden, 7 reported economic burden, and 4 reported humanistic burden (6 studies reported data on a combination of clinical, economic, and/or humanistic burden [<b>Table 1</b>]). Patients with delayed diagnosis of AxSpA generally had worse clinical outcomes, including higher disease activity (Bath Ankylosing Spondylitis Disease Activity Index), poorer mobility and physical function (Bath Ankylosing Spondylitis Functional Index), and more structural damage, compared with patients who had an earlier diagnosis (<b>Table 1</b>). Patients with delayed diagnosis also had higher healthcare costs, including costs of unnecessary treatments, and greater likelihood of work disability compared with those who had an earlier diagnosis (<b>Table 1</b>). Delayed diagnosis was associated with worse quality of life, including greater likelihood for depression and negative psychological impact (<b>Table 1</b>). <h3>Conclusion</h3> Delayed diagnosis in patients with AxSpA demonstrated a decrease in physical function, higher direct and indirect costs, and poorer quality of life. This study highlights the importance of early recognition and diagnosis of AxSpA in order to improve outcomes and mitigate extensive burden on patients and society. Therefore, further efforts by the healthcare community are warranted to increase awareness of early signs of disease and reduce the delay in diagnosis of AxSpA. <h3>Reference</h3> [1] Hutton B, et al. Ann Intern Med. 2015;163(7):566-7. <h3>Acknowledgement</h3> This study was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ. <h3>Disclosure of Interests</h3> Esther Yi Consultant for: E. Yi is a postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation., Amit Ahuja Employee of: A. Ahuja is an employee of Novartis Healthcare Pvt Ltd., Tanvi Rajput Employee of: T. Rajput is an employee of Novartis Healthcare Pvt Ltd., Aneesh George Employee of: Aneesh George is an employee of Novartis Healthcare Pvt Ltd., Yujin Park Employee of: Y. Park is an employee of Novartis.