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Antón J, Moreno Ruzafa E, Lopez Corbeto M, Bou R, Sánchez Manubens J, Carriquí Arenas S, Calzada Hernández J, Bittermann V, Estepa Guillén C, Mosquera Angarita J, Rodríguez Díez L, Iglesias E, Marti Masanet M, Lopez Montesinos B, González Fernández MI, de Lossada A, Peral C, Valderrama M, Llevat N, Montoro Álvarez M, Calvo Penadés I. Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain. J Health Econ Outcomes Res 2023; 10:141-149. [PMID: 38145114 PMCID: PMC10742379 DOI: 10.36469/001c.85088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/07/2023] [Indexed: 12/26/2023]
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.
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Affiliation(s)
- Jordi Antón
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Mireia Lopez Corbeto
- Pediatric Rheumatology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa Bou
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | - Judith Sánchez Manubens
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
- Servei de Pediatria, Hospital Parc Taulí Sabadell
| | | | | | - Violetta Bittermann
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | | | | | | | - Estíbaliz Iglesias
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | - Miguel Marti Masanet
- Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Berta Lopez Montesinos
- Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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