The economic impact of intermittent high-dose intravenous versus oral corticosteroid treatment of juvenile dermatomyositis.
OBJECTIVE
To perform a cost-identification and cost-effectiveness analysis comparing oral corticosteroids (OCS) with high-dose intermittent intravenous corticosteroid (IVCS) regimens in the treatment of juvenile dermatomyositis (JDM).


METHODS
Children previously diagnosed and treated for JDM (without myositis-specific or myositis-associated autoantibodies) at a single medical center by a single provider were identified. Two treatment protocols were compared: OCS and IVCS. Data on initial disease severity, time to remission, resource use, and costs generated were collected from patient records. Incremental cost-effectiveness ratios (ICE) were constructed.


RESULTS
Patients treated with IVCS achieved median remission 2 years earlier at median increased cost of $13,736. The ICE ratio comparing IVCS to OCS is $6,868 per year of disease avoided.


CONCLUSIONS
This study suggests that, although IVCS treatments are costly, they are cost-effective.
Klein-Gitelman
M S
MS
Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA.
Waters
T
T
Pachman
L M
LM
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000191:economics*; D002641:Chicago; D002675:Child, Preschool; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003882:Dermatomyositis / Q000188:drug therapy* / Q000191:economics*; D004180:Direct Service Costs / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D007262:Infusions, Intravenous / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones