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]

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]

• 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 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

• 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.

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