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Marshall DA, Gerber B, Currie GR, Antón J, De Somer L, Dey M, Egert T, Egert Y, Henan L, Klotsche J, Mifsut LM, Minden K, Normand C, Porte D, Saurenmann RK, Swart JF, Uziel Y, Wilson J, Wouters C, Ziv A, Benseler SM. Uncovering the hidden socioeconomic impact of juvenile idiopathic arthritis and paving the way for other rare childhood diseases: an international, cross-disciplinary, patient-centered approach (PAVE Consortium). Pediatr Rheumatol Online J 2024; 22:74. [PMID: 39118107 PMCID: PMC11312924 DOI: 10.1186/s12969-024-01012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) refers to a heterogeneous group of rheumatic conditions in children. Novel drugs have greatly improved disease outcomes; however, outcomes are impacted by limited awareness of the importance of early diagnosis and adequate treatment, and by differences in access across health systems. As a result, patients with JIA continue to be at risk for short- and long-term morbidity, as well as impacts on virtually all aspects of life of the child and family. MAIN BODY Literature on the socioeconomic burden of JIA is largely focused on healthcare costs, and the impact of JIA on patients, families, and communities is not well understood. High quality evidence on the impact of JIA is needed to ensure that patients are receiving necessary support, timely diagnostics, and adequate treatment, and to inform decision making and resource allocation. This commentary introduces the European Joint Programme on Rare Diseases: Producing an Arthritis Value Framework with Economic Evidence: Paving the Way for Rare Childhood Diseases (PAVE) project, which will co-develop a patient-informed value framework to measure the impact of JIA on individuals and on society. With a patient-centered approach, fundamental to PAVE is the involvement of three patient advocacy organizations from Canada, Israel, and Europe, as active research partners co-designing all project phases and ensuring robust patient and family engagement. The framework will build on the findings of projects from six countries: Canada, Germany, Switzerland, Spain, Israel, and Belgium, exploring costs, outcomes (health, well-being), and unmet needs (uveitis, mental health, equity). CONCLUSION This unique international collaboration will combine evidence on costs (from family to societal), outcomes (clinical, patient and family outcomes), and unmet needs, to co-design and build a framework with patients and families to capture the full impact of JIA. The framework will support the development of high-quality evidence, encompassing economic and clinical considerations, unmet needs, and patient perspectives, to inform equitable resource allocation, health system planning, and quality of care better aligned with the needs of children with JIA, their families, and communities. Knowledge gained from this novel approach may pave the way forward to be applied more broadly to other rare childhood diseases.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Brittany Gerber
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gillian R Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
- University of Calgary, Health Research Innovation Centre, Room 3C56, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Jordi Antón
- Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, ERN RITA and ReCONNET Center, Esplugues de Llobregat, Barcelona, Spain
- Department of Surgery, Surgical Specialties and Pediatrics, Universitat de Barcelona, Barcelona, Spain
- Study Group of Diseases Due to Immune Dysfunction in Pediatrics (GEMDIP), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Lien De Somer
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
- Pediatric Rheumatology Leuven University Hospital, Leuven, Belgium
| | - Michelle Dey
- School of Health Science, Institute of Public Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Tsipi Egert
- INBAR - Israeli Arthritis Foundation, Ramat Gan, Israel
| | - Yona Egert
- INBAR - Israeli Arthritis Foundation, Ramat Gan, Israel
| | - Lia Henan
- Meir Medical Center, Department of Pediatrics, Pediatric Rheumatology Unit, Kfar Saba, Israel
| | | | | | - Kirsten Minden
- German Rheumatism Research Centre, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christophe Normand
- European Network for Children With Arthritis and Autoinflammatory Diseases (ENCA), Gradignan, France
| | - David Porte
- Cassie and Friends Society, Vancouver, Canada
| | - Rotraud K Saurenmann
- Department of Pediatrics, Cantonal Hospital Winterthur, Brauerstr, Winterthur, Switzerland
| | - Joost F Swart
- Department of Pediatric Immunology, Wilhelmina Children's Hospital / University Medical Center, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Yosef Uziel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
| | | | - Carine Wouters
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
- Pediatric Rheumatology Leuven University Hospital, Leuven, Belgium
| | - Amit Ziv
- Meir Medical Center, Department of Pediatrics, Pediatric Rheumatology Unit, Kfar Saba, Israel
| | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
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Gowda NC, Chatterjee R, Balakrishnan A, Lawrence A, Aggarwal A. Caregiver burden in families of children with juvenile idiopathic arthritis in India. Clin Rheumatol 2024; 43:2009-2019. [PMID: 38662098 DOI: 10.1007/s10067-024-06975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
Juvenile Idiopathic Arthritis (JIA) causes caregiver burden on families with children affected with it. Our study aimed to explore this multifaceted burden in the Indian context. In this cross-sectional study, we administered the Hindi translated CAREGIVER questionnaire to adult caregivers in the families of JIA patients ≤ 18 years. The responses to the 28 items were used to calculate the burden scores in various dimensions. The relationship of the global burden scores with demographic and socioeconomic factors were analysed. Non parametric tests were used. Two hundred twenty-one caregivers participated with a median age of 39 years (IQR 32-45). This included 116 fathers, 50 mothers, 32 brothers, 18 uncles, three grandfathers, one sister, and one grandmother. The JIA patients had a median age of 15 (12-17) years, and the male-to-female ratio was 3.2:1. Enthesitis-related arthritis was the predominant subtype (72.4%). Most caregivers (70.6%) expressed sadness at diagnosis, and 29.9% continued to express sadness. Nearly two-thirds (65.6%) had to borrow money from others. More than half (59.3%) of the caregivers neglected their health, and 9.0% became sick. Male gender of the child, systemic JIA subtype, low socioeconomic status, high disease activity, extra-articular damage, high parent-reported disease activity and poor quality of life were associated with higher global caregiver burden. JIA has a significant emotional, social, economic, and labour impact on caregivers. Economic and psychosocial support needs to be given to family caregivers caring for children with JIA.
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Affiliation(s)
- Nikhil C Gowda
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Rudrarpan Chatterjee
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Anu Balakrishnan
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Able Lawrence
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 226014.
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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. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 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] [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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Marshall DA, Gerber B, Lorenzetti DL, MacDonald KV, Bohach RJ, Currie GR. Are We Capturing the Socioeconomic Burden of Rare Genetic Disease? A Scoping Review of Economic Evaluations and Cost-of-Illness Studies. PHARMACOECONOMICS 2023; 41:1563-1588. [PMID: 37594668 DOI: 10.1007/s40273-023-01308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Rare diseases have a significant impact on patients, families, the health system, and society. Measuring the socioeconomic burden is crucial to valuing interventions for rare diseases. Healthcare system costs are significant, but so are costs to other government sectors, patients, families, and society. To understand the breadth of costs captured in rare disease studies, we examined the cost categories and elements of socioeconomic burden captured in published studies. METHODS A scoping review was conducted using five electronic databases to identify English language economic evaluations and cost-of-illness studies of interventions for rare diseases (2011-21). We mapped costs using a previously developed evidence-informed framework of socioeconomic burden costs for rare disease. RESULTS Of 4890 studies identified, 48 economic evaluations and 22 cost-of-illness studies were included. While 18/22 cost-of-illness studies utilized a societal perspective, only 7/48 economic evaluations incorporated societal costs. Most reported cost categories related to medical costs, with medication and hospitalizations being the most common elements for both study designs. Costs borne by patients, families, and society were reported less among economic evaluations than cost-of-illness studies. These included: productivity (10% vs 77%), travel/accommodation (6% vs 68%), government benefits (4% vs 18%), and family impacts (0% vs 50%). CONCLUSIONS Contrary to cost-of-illness analyses, most of the included economic evaluations did not account for the hidden burden of rare diseases, that is, costs borne by patients, families, and societies. Including these types of costs in future studies would provide a more comprehensive picture of the burden of disease, providing empirical data to inform how we value and make decisions regarding rare disease interventions, health policy, and resource allocation.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Brittany Gerber
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Riley Jewel Bohach
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Gillian R Currie
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
- Department of Pediatrics, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Kip MMA, de Roock S, van den Berg I, Currie G, Marshall DA, Grazziotin LR, Twilt M, Yeung RSM, Benseler SM, Vastert SJ, Wulffraat N, Swart JF, IJzerman MJ. Costs of Hospital-Associated Care for Patients With Juvenile Idiopathic Arthritis in the Dutch Health Care System. Arthritis Care Res (Hoboken) 2022; 74:1585-1592. [PMID: 33938161 PMCID: PMC9796352 DOI: 10.1002/acr.24621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to quantify costs of hospital-associated care for juvenile idiopathic arthritis (JIA), provide insights in patient-level variation in costs, and investigate costs over time from the moment of JIA diagnosis. Results were reported for all JIA patients in general and by subtype. METHODS: This study was a single-center, retrospective analysis of prospective data from electronic medical records of children with JIA, ages 0-18 years, between April 1, 2011 and March 31, 2019. Patient characteristics (age, sex, JIA subtype) and hospital-based resource use (consultations, medication, radiology procedures, laboratory testing, surgeries, emergency department [ED] visits, hospital stays) were extracted and analyzed. Unit prices were obtained from Dutch reimbursement lists and pharmaceutical and hospital list prices. RESULTS The analysis included 691 patients. The mean total cost of hospital care was €3,784/patient/year, of which €2,103 (55.6%) was attributable to medication. Other costs involved pediatric rheumatologist visits (€633/patient/year [16.7%]), hospital stays (€439/patient/year [11.6%]), other within-hospital specialist visits (€324/patient/year [8.6%]), radiology procedures (€119/patient/year [3.1%]), laboratory tests (€114/patient/year [3.0%]), surgeries (€46/patient/year [1.2%]), and ED visits (€6/patient/year [0.2%]). Mean annual total costs varied between JIA subtypes and between individuals and were the highest for systemic JIA (€7,772/patient/year). Over the treatment course, costs were the highest in the first month after JIA diagnosis. CONCLUSION Hospital care costs of JIA vary substantially between individuals, between subtypes, and over the treatment course. The highest annual costs were for systemic JIA, primarily attributable to medication (i.e., biologics). Costs of other hospital-associated care were comparable regardless of subtype.
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Affiliation(s)
- Michelle M. A. Kip
- Wilhelmina Children's Hospital, Utrecht, The Netherlands, and University of TwenteEnschedeThe Netherlands
| | - Sytze de Roock
- Wilhelmina Children's Hospital and Utrecht UniversityUtrechtThe Netherlands
| | | | | | | | | | | | | | | | | | - Nico Wulffraat
- Wilhelmina Children's Hospital and Utrecht UniversityUtrechtThe Netherlands
| | - Joost F. Swart
- Wilhelmina Children's Hospital and Utrecht UniversityUtrechtThe Netherlands
| | - Maarten J. IJzerman
- University of Twente, Enschede, The Netherlands, and University of MelbourneMelbourneAustralia
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Tsimicalis A, Gasse M, Morand M, Rauch F. Use of Netnography to Understand GoFundMe® Crowdfunding Profiles Posted for Individuals and Families of Children with Osteogenesis Imperfecta. Healthcare (Basel) 2022; 10:healthcare10081451. [PMID: 36011107 PMCID: PMC9407832 DOI: 10.3390/healthcare10081451] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/04/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder associated with low bone density and increased bone fragility. OI can lead to a variety of supportive and medical care needs; yet financial impacts for families and individuals living with OI remain understudied and largely invisible. Efforts by families to recover costs through GoFundMe®, the most important crowdfunding web platform worldwide, offer an unprecedented opportunity to gain insight into OI costs. The purpose of this study was to describe GoFundMe® profiles and determine what factors may contribute to funding goal achievement. A netnographic approach was used to investigate a publicly available dataset from GoFundMe®, with 1206 webpages extracted and 401 included for analysis. Most webpages originated from the United States and were created by family members. Nineteen cost categories were identified. Thirty-seven web profiles met their funding goal. Funding increases or goal achievements created for children were associated with increased social-media exposure (i.e., Facebook). This study helped to describe and showcase the financial impacts of OI and effectiveness of a crowdfunding website to alleviate costs. The results highlight the need for further research to better understand OI costs and provide economic supports for individuals with OI.
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Affiliation(s)
- Argerie Tsimicalis
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada; (M.G.); (M.M.)
- Shriners Hospitals for Children, Montreal, QC H4A 0A9, Canada;
- Correspondence:
| | - Michael Gasse
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada; (M.G.); (M.M.)
| | - Marilyn Morand
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada; (M.G.); (M.M.)
| | - Frank Rauch
- Shriners Hospitals for Children, Montreal, QC H4A 0A9, Canada;
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
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Kearsley-Fleet L, Klotsche J, van Straalen JW, Costello W, D’Angelo G, Giancane G, Horneff G, Klein A, Láday M, Lunt M, de Roock S, Ruperto N, Schoemaker C, Vijatov-Djuric G, Vojinovic J, Vougiouka O, Wulffraat NM, Hyrich KL, Minden K, Swart JF. Burden of comorbid conditions in children and young people with juvenile idiopathic arthritis: a collaborative analysis of 3 JIA registries. Rheumatology (Oxford) 2022; 61:2524-2534. [PMID: 34613385 PMCID: PMC9157174 DOI: 10.1093/rheumatology/keab641] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally-UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild-to quantify the occurrence of selected comorbidities in patients with JIA. METHODS Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. RESULTS 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1-1.8%) and uveitis (15-19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). CONCLUSION This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Joeri W van Straalen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | - Wendy Costello
- iIrish Children’s Arthritis Network (iCAN), Bansha, Co Tipperary, Ireland
| | | | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Ariane Klein
- Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Matilda Láday
- Pediatric Clinical Department 1, Spitalul Clinic Judetean De Urgenta, Tîrgu-Mureș, Romania
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sytze de Roock
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Casper Schoemaker
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
- Dutch JIA Patient and Parent Organisation (Member of ENCA), Rijen, The Netherlands
| | - Gordana Vijatov-Djuric
- Faculty of Medicine, University of Novi Sad
- Department of Immunology, Allergology and Rheumatology, Institute for Child and Youth Health Care of Vojvodina, Novi Sad
| | - Jelena Vojinovic
- Faculty of Medicine, Department of Pediatric Immunology and Rheumatology, University of Nis, University Clinic Center
- Department of Pediatric Rheumatology, Clinical Center Nis, Clinic of Pediatrics, Nis, Serbia
| | - Olga Vougiouka
- ‘P a A Kyriakou’ Children’s Hospital, 2nd Paediatric Department, Athens University School of Medicine, Athens, Greece
| | - Nico M Wulffraat
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | | | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester BRC, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joost F Swart
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
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Nandi M, Majhi A, Samanta M, Sar T, Sarkar S, Sabui T. Health-related quality of life in children with juvenile idiopathic arthritis: A developing country perspective. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_259_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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García-Rodríguez F, Gamboa-Alonso A, Jiménez-Hernández S, Ochoa-Alderete L, Barrientos-Martínez VA, Alvarez-Villalobos NA, Luna-Ruíz GA, Peláez-Ballestas I, Villarreal-Treviño AV, de la O-Cavazos ME, Rubio-Pérez N. Economic impact of Juvenile Idiopathic Arthritis: a systematic review. Pediatr Rheumatol Online J 2021; 19:152. [PMID: 34627296 PMCID: PMC8502332 DOI: 10.1186/s12969-021-00641-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) requires complex care that generate elevated costs, which results in a high economic impact for the family. The aim of this systematic review was to collect and cluster the information currently available on healthcare costs associated with JIA after the introduction of biological therapies. METHODS We comprehensively searched in MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Databases for studies from January 2000 to March 2021. Reviewers working independently and in duplicate appraised the quality and included primary studies that report total, direct and/or indirect costs related to JIA for at least one year. The costs were converted to United States dollars and an inflationary adjustment was made. RESULTS We found 18 eligible studies including data from 6,540 patients. Total costs were reported in 10 articles, ranging from $310 USD to $44,832 USD annually. Direct costs were reported in 16 articles ($193 USD to $32,446 USD), showing a proportion of 55 to 98 % of total costs. Those costs were mostly related to medications and medical appointments. Six studies reported indirect costs ($117 USD to $12,385 USD). Four studies reported costs according to JIA category observing the highest in polyarticular JIA. Total and direct costs increased up to three times after biological therapy initiation. A high risk of reporting bias and inconsistency of the methodology used were found. CONCLUSION The costs of JIA are substantial, and the highest are derived from medication and medical appointments. Indirect costs of JIA are underrepresented in costs analysis.
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Affiliation(s)
- Fernando García-Rodríguez
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Augusto Gamboa-Alonso
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Sol Jiménez-Hernández
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Lucero Ochoa-Alderete
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Valeria Alejandra Barrientos-Martínez
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | | | | | | | - Ana Victoria Villarreal-Treviño
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Manuel Enrique de la O-Cavazos
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Nadina Rubio-Pérez
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico.
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Concha S, Morales PS, Talesnik E, Borzutzky A. Changes in Treatments and Outcomes After Implementation of a National Universal Access Program for Juvenile Idiopathic Arthritis. J Rheumatol 2021; 48:1725-1731. [PMID: 33934075 DOI: 10.3899/jrheum.210011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the clinical and demographic characteristics of patients with juvenile idiopathic arthritis ( JIA) in Chile and compare treatments and outcomes before and after the introduction in 2010 of the Explicit Health Guarantees (GES) for JIA, a national universal access program for diagnosis and treatment of this condition. METHODS The clinical records of 280 patients with JIA followed at a private tertiary academic health network between 2007 and 2018 were reviewed. RESULTS Seventy percent of patients with JIA were female, mean age at diagnosis was 8.5 ± 4.8 years and mean follow-up was 4.0 ± 3.7 years. After GES implementation (post-GES), time to evaluation by pediatric rheumatologist and diagnostic delay were significantly reduced (15.0 ± 4.5 vs 9.0 ± 4.2 months, P = 0.004). In addition, use of magnetic resonance imaging significantly increased post-GES (P < 0.001). In terms of JIA treatments, before GES implementation, no patients received biologics. Of the 67 patients diagnosed before 2010 with continued follow-up at our center, 34% began biologic treatment after GES implementation. Of 196 patients diagnosed post-GES, 46% were treated with biologics. JIA remission rates were significantly higher in patients diagnosed post-GES compared to pre-GES (43% vs 29%, P = 0.02). Post-GES, we observed a significant decrease in uveitis complications among JIA patients (45% vs 13%, P = 0.04). CONCLUSION The implementation of a national government-mandated universal access program for guaranteed JIA diagnosis and treatment led to earlier access to a pediatric rheumatologist and JIA diagnosis, increased rates of treatment with biologic drugs, higher rates of clinical remission, and lower rates of uveitis complications in Chilean children with JIA.
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Affiliation(s)
- Sara Concha
- S. Concha, MD, P.S. Morales, MD, E. Talesnik, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile; A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, and Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. The authors declare no conflicts of interest. Address correspondence to Dr. A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362 of. 807, Santiago, Chile 8330077. . Accepted for publication April 20, 2021
| | - Pamela S Morales
- S. Concha, MD, P.S. Morales, MD, E. Talesnik, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile; A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, and Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. The authors declare no conflicts of interest. Address correspondence to Dr. A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362 of. 807, Santiago, Chile 8330077. . Accepted for publication April 20, 2021
| | - Eduardo Talesnik
- S. Concha, MD, P.S. Morales, MD, E. Talesnik, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile; A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, and Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. The authors declare no conflicts of interest. Address correspondence to Dr. A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362 of. 807, Santiago, Chile 8330077. . Accepted for publication April 20, 2021
| | - Arturo Borzutzky
- S. Concha, MD, P.S. Morales, MD, E. Talesnik, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile; A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, and Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. The authors declare no conflicts of interest. Address correspondence to Dr. A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362 of. 807, Santiago, Chile 8330077. . Accepted for publication April 20, 2021
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Armeni P, Cavazza M, Xoxi E, Taruscio D, Kodra Y. Reflections on the Importance of Cost of Illness Analysis in Rare Diseases: A Proposal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1101. [PMID: 33530652 PMCID: PMC7908548 DOI: 10.3390/ijerph18031101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/09/2021] [Accepted: 01/20/2021] [Indexed: 11/23/2022]
Abstract
In the field of rare diseases (RDs), the evidence standard is often lower than that required by health technology assessment (HTA) and payer authorities. In this commentary, we propose that appropriate economic evaluation for rare disease treatments should be initially informed by cost-of-illness (COI) studies conducted using a societal perspective. Such an approach contributes to improving countries' understanding of RDs in their entirety as societal and not merely clinical, or product-specific issues. In order to exemplify how the disease burden's distribution has changed over the last fifteen years, key COI studies for Hemophilia, Fragile X Syndrome, Cystic Fibrosis, and Juvenile Idiopathic Arthritis are examined. Evidence shows that, besides methodological variability and cross-country differences, the disease burden's share represented by direct costs generally grows over time as novel treatments become available. Hence, to support effective decision-making processes, it seems necessary to assess the re-allocation of the burden produced by new medicinal products, and this approach requires identifying cost drivers through COI studies with robust design and standardized methodology.
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Affiliation(s)
- Patrizio Armeni
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, 20136 Milan, Italy;
| | - Marianna Cavazza
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, 20136 Milan, Italy;
| | - Entela Xoxi
- Independent Pharmacologist Scientific Advisor in Rare Disease Pharmaceuticals and Registries, 00184 Rome, Italy;
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, 00162 Rome, Italy; (D.T.); (Y.K.)
| | - Yllka Kodra
- National Centre for Rare Diseases, Istituto Superiore di Sanità, 00162 Rome, Italy; (D.T.); (Y.K.)
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Kip MMA, de Roock S, Currie G, Marshall DA, Grazziotin LR, Twilt M, Yeung RSM, Benseler SM, Schreijer MA, Vastert SJ, Wulffraat N, van Royen-Kerkhof A, Swart JF, IJzerman MJ. Costs of medication use among patients with juvenile idiopathic arthritis in the Dutch healthcare system. Expert Rev Pharmacoecon Outcomes Res 2020; 21:975-984. [PMID: 33243033 DOI: 10.1080/14737167.2021.1857241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: This study aims to quantify medication costs in juvenile idiopathic arthritis (JIA), based on subtype.Research design and methods: This study is a single-center, retrospective analysis of prospective data from electronic medical records of JIA patients, aged 0-18 years between 1 April 2011 and 31 March 2019. Patient characteristics (age, gender, subtype) and medication use were extracted. Medication use and costs were reported as: 1) mean total annual costs; 2) between-patient heterogeneity in these costs; 3) duration of medication use; and, 4) costs over the treatment course.Results: The analysis included 691 patients. Mean total medication costs were €2,103/patient/year, including €1,930/patient/year (91.8%) spent on biologicals. Costs varied considerably between subtypes, with polyarticular rheumatoid-factor positive and systemic JIA patients having the highest mean costs (€5,020/patient/year and €4,790/patient/year, respectively). Mean annual medication costs over the patient's treatment course ranged from <€1,000/year (71.1% of patients) to >€11,000/year (2.5% of patients). Etanercept and adalimumab were the most commonly used biologicals. Cost fluctuations over the treatment course were primarily attributable to biological use.Conclusions: Polyarticular rheumatoid-factor positive and systemic JIA patients had the highest mean total annual medication costs, primarily attributable to biologicals. Costs varied considerably between subtypes, individuals, and over the treatment course.
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Affiliation(s)
- Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases)
| | - Sytze de Roock
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Gillian Currie
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Luiza R Grazziotin
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinka Twilt
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rae S M Yeung
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Division of Rheumatology, the Hospital for Sick Children, Department of Paediatrics, Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Susanne M Benseler
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maud A Schreijer
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Sebastiaan J Vastert
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands.,European Reference Network RITA (Rare Immunodeficiency Autoinflammatory and Autoimmune Diseases Network)
| | - Nico Wulffraat
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands.,European Reference Network RITA (Rare Immunodeficiency Autoinflammatory and Autoimmune Diseases Network)
| | - Annet van Royen-Kerkhof
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands.,European Reference Network RITA (Rare Immunodeficiency Autoinflammatory and Autoimmune Diseases Network)
| | - Joost F Swart
- UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands.,European Reference Network RITA (Rare Immunodeficiency Autoinflammatory and Autoimmune Diseases Network)
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,UCAN CAN-DU network (Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases).,University of Melbourne, Melbourne School of Population and Global Health, Parkville, Melbourne, Australia
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Direct Healthcare Costs Associated with Oligoarticular Juvenile Idiopathic Arthritis at a Single Center. Int J Rheumatol 2020; 2020:5640425. [PMID: 32952562 PMCID: PMC7482013 DOI: 10.1155/2020/5640425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/22/2020] [Accepted: 08/25/2020] [Indexed: 12/04/2022] Open
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.
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Ailioaie LM, Litscher G. Molecular and Cellular Mechanisms of Arthritis in Children and Adults: New Perspectives on Applied Photobiomodulation. Int J Mol Sci 2020; 21:E6565. [PMID: 32911717 PMCID: PMC7554967 DOI: 10.3390/ijms21186565] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Juvenile idiopathic arthritis and adult rheumatoid arthritis are two major groups with chronic joint pain and inflammation, extra-articular manifestations, and high risk of comorbidities, which can cause physical and ocular disability, as well as create great socio-economic pressure worldwide. The pathogenesis of arthritis manifested in childhood and adulthood is multifactorial, unclear, and overly complex, in which immunity plays an important role. Although there are more and more biological agents with different mechanisms of action for the treatment of arthritis, the results are not as expected, because there are partial responses or non-responsive patients to these compounds, high therapeutic costs, side effects, and so on; therefore, we must turn our attention to other therapeutic modalities. Updating knowledge on molecular and cellular mechanisms in the comparative pathogenesis of chronic arthritis in both children and adults is necessary in the early and correct approach to treatment. Photobiomodulation (PBM) represents a good option, offering cost-effective advantages over drug therapy, with a quicker, more positive response to treatment and no side effects. The successful management of PBM in arthritis is based on the clinician's ability to evaluate correctly the inflammatory status of the patient, to seek the optimal solution, to choose the best technology with the best physical parameters, and to select the mode of action to target very precisely the immune system and the molecular signaling pathways at the molecular level with the exact amount of quantum light energy in order to obtain the desired immune modulation and the remission of the disease. Light is a very powerful tool in medicine because it can simultaneously target many cascades of immune system activation in comparison with drugs, so PBM can perform very delicate tasks inside our cells to modulate cellular dysfunctions, helping to initiate self-organization phenomena and finally, healing the disease. Interdisciplinary teams should work diligently to meet these needs by also using single-cell imaging devices for multispectral laser photobiomodulation on immune cells.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iaşi, Romania;
- Ultramedical & Laser Clinic, 83 Arcu Street, 700135 Iaşi, Romania
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, and Traditional Chinese Medicine (TCM) Research Center Graz, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
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Grazziotin LR, Currie G, Kip MMA, IJzerman MJ, Twilt M, Lee R, Marshall DA. Health State Utility Values in Juvenile Idiopathic Arthritis: What is the Evidence? PHARMACOECONOMICS 2020; 38:913-926. [PMID: 32390065 DOI: 10.1007/s40273-020-00921-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The objectives of this systematic review were to identify health state utility values (HSUV) of children and adults with juvenile idiopathic arthritis in the literature and to assess whether HSUV were appropriately reported and could be used to inform parameter inputs for a model-based cost-utility analysis to inform decision making. METHODS MEDLINE, EMBASE, PsycINFO, EconLit and CINAHL databases were searched in July 2019. Inclusion criteria were studies using preference-based instruments, targeting children or adults with juvenile idiopathic arthritis, and in the English language. The quality of studies was assessed using a modified checklist that included relevant sources of bias and assessment of quality of HSUV valuation and measurement. A descriptive analysis was conducted, including assessment on reporting of population characteristics and stratification of HSUV by potential health states or population subgroup. RESULTS From 620 identified articles, ten reported HSUV. Seven studies reported HSUV of children with juvenile idiopathic arthritis, and three of adults with a history of juvenile idiopathic arthritis. Population disease activity status and drug treatment were reported in less than half of the studies. Six (out of ten) studies stratified HSUV results for at least one of the potential health state categories, but they represent very specific situations or interventions (e.g. patients receiving different types of physiotherapy or treated with etanercept over time). CONCLUSIONS We have identified critical gaps in the literature reporting HSUV in patients with juvenile idiopathic arthritis including a lack of HSUV measures for distinct health states, particularly in adults with a history of juvenile idiopathic arthritis. The current reported HSUV data in juvenile idiopathic arthritis are insufficient for a full cost-utility analysis with a short or lifetime horizon.
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Affiliation(s)
- Luiza Raquel Grazziotin
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Gillian Currie
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Marinka Twilt
- Division of Rheumatology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Raymond Lee
- Alberta Health Services, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
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Qian X, Liu YX, Ye X, Zheng W, Lv S, Mo M, Lin J, Wang W, Wang W, Zhang X, Lu M. Gut microbiota in children with juvenile idiopathic arthritis: characteristics, biomarker identification, and usefulness in clinical prediction. BMC Genomics 2020; 21:286. [PMID: 32264859 PMCID: PMC7137182 DOI: 10.1186/s12864-020-6703-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Background Recent studies have suggested that the gut microbiota is altered in children with juvenile idiopathic arthritis (JIA). However, age, sex, and body mass index (BMI) were not matched in the previous studies, and the results are inconsistent. We conducted an age-, sex-, and BMI-matched cross-sectional study to characterize the gut microbiota in children with JIA, and evaluate its potential in clinical prediction. Methods A total of 40 patients with JIA and 42 healthy controls, ranging from 1 to 16 years, were enrolled in this study. Fecal samples were collected for 16S rDNA sequencing. The data were analyzed using QIIME software and R packages. Specifically, the random forest model was used to identify biomarkers, and the receiver operating characteristic curve and the decision curve analysis were used to evaluate model performance. Results A total of 39 fecal samples from patients with JIA, and 42 fecal samples from healthy controls were sequenced successfully. The Chao 1 and Shannon–Wiener index in the JIA group were significantly lower than those in the control group, and the Bray-Curtis dissimilarity also differed significantly between the two groups. The relative abundance of 4 genera, Anaerostipes, Dialister, Lachnospira, and Roseburia, decreased significantly in the JIA group compared to those in the control group. The 4 genera included microbes that produce short-chain fatty acids (SCFAs) and were negatively correlated with some rheumatic indices. Moreover, 12 genera were identified as potential biomarkers by using the nested cross-validation function of the random forest. A random forest model constructed using these genera was able to differentiate the patients with JIA from the healthy controls, and the area under the receiver operating characteristic curve was 0.7975. The decision curve analysis indicated that the model had usefulness in clinical practice. Conclusions The gut microbiota in patients with JIA is altered and characterized by a decreased abundance of 4 SCFA-producing genera. The decreases in the 4 genera correlated with more serious clinical indices. Twelve genera could be used as biomarkers and predictors in clinical practice. Trial registration The study is registered online at the Chinese Clinical Trial Registry on 11 May 2018 (registration number: ChiCTR1800016110).
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Affiliation(s)
- Xubo Qian
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yong-Xin Liu
- State Key Laboratory of Plant Genomics, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Xiaohong Ye
- Department of Scientific Research Management and Medical Education, Jinhua Hospital of Traditional Chinese Medicine, Jinhua, Zhejiang Province, China
| | - Wenjie Zheng
- Department of Paediatric Rheumatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Shaoxia Lv
- Nursing Department, Jiangnan Community Healthcare Center, Jinhua, Zhejiang Province, China
| | - Miaojun Mo
- Department of Pediatrics, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
| | - Jinjing Lin
- Department of Pediatrics, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, Zhejiang Province, China
| | - Wenqin Wang
- Department of Rheumatology Immunology, Jinhua Municipal People's Hospital, Jinhua, Zhejiang Province, China
| | - Weihan Wang
- Department of Scientific Research Management and Medical Education, Jinhua Hospital of Traditional Chinese Medicine, Jinhua, Zhejiang Province, China
| | - Xianning Zhang
- Department of Genetics, Institute of Genetics, Institute of Cell Biology, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
| | - Meiping Lu
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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19
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Kip MMA, Currie G, Marshall DA, Grazziotin Lago L, Twilt M, Vastert SJ, Swart JF, Wulffraat N, Yeung RSM, Benseler SM, IJzerman MJ. Seeking the state of the art in standardized measurement of health care resource use and costs in juvenile idiopathic arthritis: a scoping review. Pediatr Rheumatol Online J 2019; 17:20. [PMID: 31060557 PMCID: PMC6501309 DOI: 10.1186/s12969-019-0321-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to describe current practice in identifying and measuring health care resource use and unit costs in economic evaluations or costing studies of juvenile idiopathic arthritis (JIA). METHODS A scoping review was conducted (in July 2018) in PubMed and Embase to identify economic evaluations, costing studies, or resource utilization studies focusing on patients with JIA. Only English language peer-reviewed articles reporting primary research were included. Data from all included full-text articles were extracted and analysed to identify the reported health care resource use items. In addition, the data sources used to obtain these resource use and unit costs were identified for all included articles. RESULTS Of 1176 unique citations identified by the search, 20 full-text articles were included. These involved 4 full economic evaluations, 5 cost-outcome descriptions, 8 cost descriptions, and 3 articles reporting only resource use. The most commonly reported health care resource use items involved medication (80%), outpatient and inpatient hospital visits (80%), laboratory tests (70%), medical professional visits (70%) and other medical visits (65%). Productivity losses of caregivers were much more often incorporated than (future) productivity losses of patients (i.e. 55% vs. 15%). Family borne costs were not commonly captured (ranging from 15% for school costs to 50% for transportation costs). Resource use was mostly obtained from family self-reported questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or literature. CONCLUSIONS Despite some consistency in commonly included health care resource use items, variability remains in including productivity losses, missed school days and family borne costs. As these items likely substantially influence the full cost impact of JIA, the heterogeneity found between the items reported in the included studies limits the comparability of the results. Therefore, standardization of resource use items and unit costs to be collected is required. This standardization will provide guidance to future research and thereby improve the quality and comparability of economic evaluations or costing studies in JIA and potentially other childhood diseases. This would allow better understanding of the burden of JIA, and to estimate how it varies across health care systems.
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Affiliation(s)
- Michelle M. A. Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - Gillian Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Deborah A. Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Luiza Grazziotin Lago
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marinka Twilt
- Division of Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Sebastiaan J. Vastert
- Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Joost F. Swart
- Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Nico Wulffraat
- Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Rae S. M. Yeung
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
| | - Susanne M. Benseler
- Division of Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Maarten J. IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
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20
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Mars NJ, Kerola AM, Kauppi MJ, Pirinen M, Elonheimo O, Sokka-Isler T. Patients with rheumatic diseases share similar patterns of healthcare resource utilization. Scand J Rheumatol 2019; 48:300-307. [PMID: 30836033 DOI: 10.1080/03009742.2018.1559878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.
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Affiliation(s)
- N J Mars
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland
| | - A M Kerola
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - M J Kauppi
- c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland.,d School of Medicine , University of Tampere , Tampere , Finland
| | - M Pirinen
- b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland.,e Helsinki Institute for Information Technology HIIT and Department of Mathematics and Statistics , University of Helsinki , Helsinki , Finland.,f Department of Public Health , University of Helsinki , Helsinki , Finland
| | - O Elonheimo
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - T Sokka-Isler
- g Department of Medicine , Jyväskylä Central Hospital , Jyväskylä , Finland
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21
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Patti A, Maggio MC, Corsello G, Messina G, Iovane A, Palma A. Evaluation of Fitness and the Balance Levels of Children with a Diagnosis of Juvenile Idiopathic Arthritis: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070806. [PMID: 28753965 PMCID: PMC5551244 DOI: 10.3390/ijerph14070806] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/14/2017] [Accepted: 07/16/2017] [Indexed: 12/18/2022]
Abstract
Background: Juvenile idiopathic arthritis is a main cause of physical disability and has high economic costs for society. The purpose of this study was to assess the fitness levels and the postural and balance deficits with a specific test battery. Methods: Fifty-six subjects were enrolled in this study. Thirty-nine healthy subjects were included in the control group and seventeen in the juvenile idiopathic arthritis group. All subjects were evaluated using a posturography system. The fitness level was evaluated with a battery of tests (Abalakov test, sit-up test, hand grip test, backsaver sit and reach, the toe touch test). An unpaired t-test was used to determine differences. Pearson’s correlation coefficient was used to evaluate the correlation between the tests. Results: The battery of tests demonstrated that subjects in the juvenile idiopathic arthritis group have lower fitness levels compared to the control group. The juvenile idiopathic arthritis group showed low postural control with respect to the control group. Pearson analysis of the juvenile idiopathic arthritis group data showed significant correlations between variables. Pearson’s results from the control group data showed a similar trend. Conclusions: The results suggest that the battery of tests used could be an appropriate tool. However, we highlight that these conclusions need to be supported by other studies with a larger population scale.
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Affiliation(s)
- Antonino Patti
- Department of Psychology and Educational Science, University of Palermo, 90133 Palermo, Italy.
| | - Maria Cristina Maggio
- Department of Science for the Promotion of Health and Infant Maternal "G. D'Alessandro", University of Palermo, 90133 Palermo, Italy.
| | - Giovanni Corsello
- Department of Science for the Promotion of Health and Infant Maternal "G. D'Alessandro", University of Palermo, 90133 Palermo, Italy.
| | - Giuseppe Messina
- Department of Psychology and Educational Science, University of Palermo, 90133 Palermo, Italy.
- Posturalab Italy, 90131 Palermo, Italy.
| | - Angelo Iovane
- Department of Psychology and Educational Science, University of Palermo, 90133 Palermo, Italy.
| | - Antonio Palma
- Department of Psychology and Educational Science, University of Palermo, 90133 Palermo, Italy.
- Regional Sport School of Sicily CONI (Olympic National Italian Committee), 90141 Palermo, Italy.
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