Medications and Medical Appointments Contribute to Highest Health Care Costs in Juvenile Idiopathic Arthritis

Health care costs associated with juvenile idiopathic arthritis (JIA) were found to be significant, with medications and medical appointments contributing to the highest costs, according to results from a systematic review published in Pediatric Rheumatology.

Authors conducted a systematic review based on data from the last 20 years to estimate the overall direct and indirect costs in patients with JIA, independent of subtype or region. Studies were included if economic evaluations (cost effectiveness, cost utility, cost benefit, cost minimization and cost consequences analysis), partial economic evaluations (cost analysis, cost description, and cost outcome), and individual studies with cost reporting (clinical trials and observational studies) were assessed.

A total of 1334 studies were identified and 18 studies were included for review, including 11 were economic studies, 3 retrospective observational, and 4 cohort studies.

From the 18 articles, data from 6540 patients was analyzed from more than 10 different countries, mostly in Europe and the US. Of these patients, the most common classification was oligoarticular JIA and patients were followed-up for up to 12 months. Annual total costs ranged from USD $1122 to $44,832, at least half of which were related to direct costs. This was noted to be higher than that reported in chronic arthritis in the adults. The report of indirect costs was scarcely reported and costs at different time points during the disease journey, such as recent diagnosis, remission, flare, maintenance, could not be distinguished.

Patients with polyarticular JIA had the highest total costs and direct costs associated with disease, which the authors noted may be associated with lower remission rates in rheumatoid factor-positive polyarticular JIA, increasing the time of therapy, or due to frequent use of biologics.

Of the 18 studies, 2 analyzed the costs before and after the start of etanercept, 1 of adalimumab, and 1 compared patients with and without biologics. The costs after the initiation of biologic therapy in JIA increased in the studies that reported an increase in direct costs, similar to data from other chronic inflammatory diseases. Indirect costs also decreased. However, the authors were unable to analyze the cost effectiveness of these therapies on JIA due to the lack of information on indirect costs, including health-related quality of life, before and after start of biologics, and the relatively short follow-up in most of the studies.

Authors also noted that despite their extensive and rigorous methodology for inclusion, it may be possible that additional costs may have been unreported, such as thesis, technical reports, and conferences. In addition, varying definitions, methodology, and consistency in the articles may have led to high risk for reporting bias. The authors noted that it was not possible to perform a meta-analysis on costs, which could have provided areas of greatest need for patients and their families. The lack of information from other developing countries limited the generalization of the results and the real burden of the disease.

However, the authors suggested that results of the systematic analysis highlighted the great variability between the studies and identifies areas for further research.

“…the information collected allows us to identify that the costs of JIA are substantial and probably the highest are derived from medication and medical appointments. Which evidences the great economic impact of JIA and how catastrophic it can be for a family,” the researchers noted.

Reference

García-Rodríguez F, Gamboa-Alonso A, Jiménez-Hernández S, et al. Economic impact of juvenile idiopathic arthritis: a systematic review. Pediatr Rheumatol. 2021;19:152. doi:10.1186/s12969-021-00641-y