Juvenile idiopathic arthritis cost-effectiveness of therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Dheeraj Makkar, M.D.[2]
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Cost-Effectiveness of Therapy
The cost-effectiveness of therapy in juvenile idiopathic arthritis (JIA) is influenced by disease subtype, severity, treatment response, and long-term outcomes. Contemporary management emphasizes early and effective disease control to reduce long-term disability, complications, and indirect healthcare costs.[1]
Conventional Therapy
- Nonsteroidal anti-inflammatory drugs and methotrexate are relatively low-cost therapies
- Early use of methotrexate is cost-effective by reducing disease activity and delaying or preventing escalation to more expensive therapies
- Effective conventional therapy decreases long-term costs related to joint damage, surgery, and disability
Biologic and Targeted Therapies
- Biologic DMARDs substantially increase direct healthcare costs
- Cost-effectiveness improves in patients with moderate-to-severe disease or poor prognostic features due to:
- Reduced disease activity and flares
- Prevention of irreversible joint damage
- Improved physical function and quality of life
- Early targeted therapy in systemic JIA may reduce cumulative costs by decreasing prolonged glucocorticoid exposure, hospitalizations, and complications such as macrophage activation syndrome
Long-Term Economic Impact
- Uncontrolled JIA is associated with increased long-term healthcare utilization, including hospitalizations, surgical interventions, and rehabilitation
- Indirect costs, including caregiver burden, missed school, and reduced productivity in adulthood, contribute significantly to overall economic impact
- Early achievement of inactive disease is associated with lower lifetime costs
Overall, while biologic therapies are associated with higher upfront costs, evidence suggests they may be cost-effective in selected patients by improving long-term outcomes and reducing cumulative disease-related morbidity.
References
- ↑ Sandborg CI, Schulert GS, Kimura Y. Juvenile Idiopathic Arthritis. N Engl J Med. 2025;392:XXX–XXX. doi:10.1056/NEJMra2402073.
- ↑ Sandborg CI, Schulert GS, Kimura Y. Juvenile Idiopathic Arthritis. N Engl J Med. 2025;392:XXX–XXX. doi:10.1056/NEJMra2402073.
- ↑ Ringold S, Angeles-Han ST, Beukelman T, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis. Arthritis Rheumatol. 2022;74:553–569. doi:10.1002/art.42036.
- ↑ Hughes DA, McCabe C. Economic evaluations of biological therapies for juvenile idiopathic arthritis. Pharmacoeconomics. 2009;27:897–913.
- ↑ Prince FH, Twilt M, Simon SC, et al. Cost-effectiveness of early aggressive treatment in juvenile idiopathic arthritis. Ann Rheum Dis. 2011;70:179–185.