Assessing The Cost Of Juvenile Arthritis

Led by Drs. Ann Clarke, Ciaran Duffy, and Sasha Bernatsky of the McGill University Health Centre in Montreal, Quebec, the study involved 155 children with JIA and 181 controls from two hospitals in Montreal and Vancouver, Canada. Subjects' parents were given a questionnaire about the use of medications and health services during the preceding three months, without specifying any particular disease. Researchers also asked parents about time loss from their work and days missed from school for the children.

The study was the first to quantify an association between JIA disease activity and health care costs and found that the difference in annualized average direct medical costs for the JIA group versus the control group was $1,686. The JIA group also had higher costs related to specialists, health care professionals, and diagnostic tests. The authors note that the "costs were higher for JIA subjects even compared with those of clinic controls, who almost certainly had greater health resource use than the generally healthy pediatric population," adding that the controls had relatively high rates of emergency room visits, assistive devices, surgeries, and inpatient stays, probably due to the fact that some were recruited from orthopedic clinics. When comparing direct medical costs of JIA patients with recent cost estimates for asthma, JIA appeared to be more costly, mostly because of higher medication costs.

The current study does not quantify the long-term medical and social costs of having inadequately controlled arthritis in childhood. "Ongoing active inflammation and the consequent joint damage have a significant impact on the ability of an individual to be a productive member of society," the authors state. They note that the JIA patients on average had more missed days of school per year compared with the controls and point out that indirect costs, such as missed time from work, are also very important from a societal perspective.

Insight into factors that influence health care costs can play an important role in resource allocation, which is increasingly important in light of economic constraints on health care systems, the authors state.

The results of the study are important in helping to quantify the magnitude of health care cost savings that could result in better disease control, especially given the development of costly new medications, the authors state. "Ultimately, decisions regarding access to therapies should be considered in terms of overall cost-benefit ratios," they conclude. "More effective interventions, even if associated with higher initial health care costs, may well have significant long-term cost savings to society."

Article: "Economic Impact of Juvenile Idiopathic Arthritis," Sasha Bernatsky, Ciaran Duffy, Peter Malleson, Debbie Ehrmann Feldman, Yvan St. Pierre, Ann E. Clarke, Arthritis Care & Research, February 2007; (DOI: 10.1002/art.22463).