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

Amit Thakral,Daniel Pinto,Marisa Klein-Gitelman,Michael Miller,Dustin D French,Megan L Curran

doi:10.1155/2020/5640425

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.

Highlights

Juvenile idiopathic arthritis (JIA) is characterized by inflammation and damage to the joints and affects approximately 1 in 1,000 children worldwide [1]
Of the patients who received intra-articular joint injections, 62% (21 patients) had joint injections performed by interventional radiology, whereas 30% (10 patients) had joint injections in the operating room, and 6% (2 patients) in our outpatient clinic, respectively. 27% (26 patients) had a diagnosis of uveitis documented in our electronic medical record (EMR). 76% of patients were classified as having persistent oligoarticular JIA
A medication profile of the 97 patients is shown in Table 2. 32% of patients were prescribed a biologic during the four-year study period, predominantly in conjunction with other medications, while 23% of patients received only NSAIDs over the four-year period. 20% of patients were prescribed oral steroids during the study period

Summary

Introduction

Juvenile idiopathic arthritis (JIA) is characterized by inflammation and damage to the joints and affects approximately 1 in 1,000 children worldwide [1]. Being the most common rheumatic disease in childhood, JIA is a chronic disease that can have a serious impact on quality of life even when controlled [2]. Little is known about the economic impact of oligoarticular JIA [3]. According to the International League of Associations for Rheumatology (ILAR), JIA is classified into seven categories based on clinical and laboratory features that present in the first 6 months [4]. Oligoarticular JIA, one of the most common JIA subtypes, affects four or fewer joints during the first 6 months of illness [5]

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