title: Cost-effectiveness of biologics in polyarticular-course juvenile idiopathic arthritis patients unresponsive to disease-modifying antirheumatic drugs.
abstract: OBJECTIVE
  Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric rheumatic disease and can have long-term effects leading to disability in adulthood. Biologics are a new class of drugs increasingly used to treat JIA. The primary study objective was to determine the incremental costs of biologics per additional responder compared to conventional treatment (methotrexate).
  
  
  METHODS
  A separate decision model was created for etanercept, infliximab, adalimumab, and abatacept. The study population consisted of polyarticular-course JIA patients with a prior inadequate response or intolerance to disease-modifying antirheumatic drugs (DMARDs). The effectiveness measure was the proportion of patients who had a treatment response at 1 year according to the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30) improvement criteria. Direct and indirect costs were calculated in 2008 Canadian dollars. Incremental cost-effectiveness ratios and 95% confidence intervals (95% CIs) were calculated for each biologic agent using probabilistic sensitivity analyses.
  
  
  RESULTS
  The additional costs per additional ACR Pedi 30 responder at 1 year were $26,061 (95% CI $17,070, $41,834), $46,711 (95% CI $30,042, $75,787), $16,204 (95% CI $11,393, $22,608), and $31,209 (95% CI $16,659, $66,220) for etanercept, adalimumab, abatacept, and infliximab, respectively.
  
  
  CONCLUSIONS
  Biologics are more effective than methotrexate in achieving a short-term response in JIA patients with prior inadequate responses to DMARDs; however, this comes at a high annual cost. Adequate long-term data with respect to both safety and effectiveness are not currently available, nor are utility estimates. Such data will be important to estimate value for money for treating JIA with biologic drugs over the long term.
authors.affiliation: The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. wendy.ungar@sickkids.ca
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Ungar
authors.forename: Vania
authors.initials: V
authors.lastname: Costa
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hancock-Howard
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Laxer
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000191:economics* / Q000628:therapy; D001688:Biological Products / Q000191:economics* / Q000627:therapeutic use; D002358:Cartilage, Articular / Q000473:pathology; D003362:Cost-Benefit Analysis / Q000191:economics; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000191:economics; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products