Direct Healthcare Costs Associated with Oligoarticular Juvenile Idiopathic Arthritis at a Single Center

Abstract

Oligoarticular juvenile idiopathic arthritis (JIA) is a common disease in pediatric rheumatology. The management of oligoarticular JIA can result in a considerable economic burden. This study is a four-year, retrospective cost identification analysis performed to determine the annual direct cost of care for patients with oligoarticular JIA and possible predictive clinical factors. Direct healthcare costs were defined as those associated with office visits, laboratory studies, hospital admissions, joint injections, medications, infusions, radiology tests, and emergency room visits. Disease characteristics and patient information included ANA status, gender, age at diagnosis, duration from diagnosis to initial visit during the study period, and whether uveitis had been diagnosed. We identified 97 patients with oligoarticular JIA eligible for the study. The median age of diagnosis was 4.3 years. Positive ANA were noted in 75% of patients. 34% of patients received at least one intra-articular steroid injection. 32% of patients were prescribed a biologic during the study period, predominantly with other medications, while 23% of patients received only NSAIDs. 20% of patients were prescribed oral steroids. The average total direct medical cost in this study per year for an oligoarticular JIA patient was $3929±6985. Medications accounted for 85% of annual direct medical costs. Clinic visits and laboratory testing accounted for 8% and 5%, respectively. Patient characteristics and demographics were tested for association with direct medical costs by the Wilcoxon rank sum test and Kruskal-Wallis test. Patients who were ANA positive had increased annual costs compared to patients who are ANA negative. ANA-positive patients were found to have statistically significant costs, particularly, in laboratory tests, procedural costs, radiology costs, and medication costs. The results reported here provide information when allocating healthcare resources and a better understanding of the economic impact oligoarticular JIA has on the United States healthcare system.

Overview of the economic burden of musculoskeletal pain in children and adolescents: a systematic review with meta-analysis

“…Fifteen studies 10,17,19,24,34,37,47,56–58,60,61,63,69,81 included children and adolescents with mixed pain conditions, 13 studies 2,9,15,20,29,31,32,42,52,59,66,68,80 with juvenile idiopathic arthritis, 10 studies 3–5,14,28,35,40,46,62,71 with headache/migraine, and 7 studies 36,41,44,55,67,72,79 with adolescent idiopathic scoliosis. Nineteen were cross-sectional studies, 3–5,9,19,28,32,35,41,42,44,46,47,59,62,69,71,72,80 25 were cohort studies 2,10,14,15,17,20,24,29,31,36,37,40,52,55–58,60,61,63,66–68,79,81 of which 11 provided some type of intervention with cost data collected at baseline or before the intervention, 10,17,20,24,37,52,56–58,61,63 and 1 was a randomized controlled trial with cost data collected at baseline.…”

“…Fifteen studies 10,17,19,24,34,37,47,56–58,60,61,63,69,81 included children and adolescents with mixed pain conditions, 13 studies 2,9,15,20,29,31,32,42,52,59,66,68,80 with juvenile idiopathic arthritis, 10 studies 3–5,14,28,35,40,46,62,71 with headache/migraine, and 7 studies 36,41,44,55,67,72,79 with adolescent idiopathic scoliosis. Nineteen were cross-sectional studies, 3–5,9,19,28,32,35,41,42,44,46,47,59,62,69,71,72,80 25 were cohort studies 2,10,14,15,17,20,24,29,31,36,37,40,52,55–58,60,61,63,66–68,79,81 of which 11 provided some type of intervention with cost data collected at baseline or before the intervention, 10,17,20,24,37,52,56–58,61,63 and 1 was a randomized controlled trial with cost data collected at baseline. 34 Seventeen studies were conducted in the United States (37.8%), 3,10,14,17,19,24,34,35,41,55,61,62,66,69,71,79,81 7 in Germany (15.6%), 37,42,46,47,56–58 5 in Canada (11%), 2,9,15,44,63 3 in Turkey (6.7%), 28,72,80 2 in Brazil (4.4%), 4,5 2 in the United Kingdom (4.4%), 60,68 2 in the Netherlands (4.4%) 31,52 1 in Finland (2.2%), 20 1 in Italy (2.2%), 40 1 in Singapore (2.2%), 67 1 in China (2.2%), 36 and 1 in India (2.2%).…”

Economic impact of Juvenile Idiopathic Arthritis: a systematic review

“…1). Eleven were economic studies [1,7,[14][15][16][17][18][19][20][21][22], three retrospective observational [23][24][25] and four cohorts [4,[26][27][28].…”

“…In 11 articles it was possible to obtain data on JIA classification (2,121 patients), being oligoarticular the most frequent (Supplementary Table 1). The follow-up was 12 months in 11 studies [1,4,7,15,17,18,20,22,[26][27][28], in the rest it was variable with a maximum of 10 years [14,16,19,21,[23][24][25] (Table 1).…”

“…DC were reported in 16 articles, which ranged between 193 [15] and 32,446 [7] USD. Lower costs were observed in the Indian report [15] followed by those from Canada [4,23], while costs of Europe [7, 16-19, 22, 24-27] and the USA [20,21,28] were variable, but consistently higher. Eight studies reported TC and DC, showing a proportion of 55 to 98 % [4,7,15,17,18,20,26,27].…”