Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain

Author:

Antón Jordi12,Moreno Ruzafa Estefania3,Lopez Corbeto Mireia3,Bou Rosa1,Sánchez Manubens Judith14,Carriquí Arenas Sonia1,Calzada Hernández Joan1,Bittermann Violetta1,Estepa Guillén Carolina1,Mosquera Angarita Juan1,Rodríguez Díez Lucía1,Iglesias Estíbaliz1,Marti Masanet Miguel5,Lopez Montesinos Berta6,González Fernández Maria I.6,de Lossada Alfonso7,Peral Carmen7,Valderrama Mónica7,Llevat Noelia7,Montoro Álvarez María7,Calvo Penadés Immaculada5

Affiliation:

1. Hospital San Joan de Déu, Barcelona, Spain

2. Universitat Autònoma de Barcelona, Barcelona, Spain

3. Pediatric Rheumatology Section, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain

4. Servei de Pediatria, Hospital Parc Taulí Sabadell

5. Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain

6. Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

7. Pfizer SLU, Alcobendas-Madrid, Spain

Abstract

Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.

Publisher

The Journal of Health Economics and Outcomes Research

Subject

Public Health, Environmental and Occupational Health,Health Policy

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