title: An analysis of the costs and treatment success of etanercept in juvenile idiopathic arthritis: results from the Dutch Arthritis and Biologicals in Children register.
abstract: OBJECTIVE
  To analyse and report the costs and effects of etanercept therapy in patients with JIA.
  
  
  METHODS
  Forty-nine JIA patients were evaluated by means of the JIA core set at the start of etanercept and after 3, 15 and 27 months of therapy. At the same time-points, parents of the patients were asked to complete the Health Utility Index Mark 3 (HUI3). Direct medical costs were collected for 1 year before and 27 months after the start of etanercept and compared with gain in utility.
  
  
  RESULTS
  Mean total direct medical costs after the start of etanercept were on average 12 478 euros per patient-year compared with 3720 euros before start. The cost analysis showed that three-quarters of total direct medical costs were from etanercept itself. Other direct medical costs, such as costs concerning hospitalization and concomitant medication, decreased compared with the costs in the period before start of etanercept. Especially a great reduction of consultations at the outpatient clinic was seen. Utility was 0.53 before start of etanercept, according to the multi-attribute utility function of the HUI3 on a scale from 0 (dead) to 1 (perfect health). After 27 months, utility was 0.78. In accordance, also all JIA core set response variables improved significantly over 27 months of etanercept treatment.
  
  
  CONCLUSIONS
  Although costs of etanercept therapy are substantial, the gain in utility is even more impressive. Considering that these JIA patients were previously refractory to conventional treatment including MTX, and were at risk of long-time disability and pain, costs are justifiable.
authors.affiliation: Department of Paediatrics/ Paediatric Rheumatology, Room Sp-1546, Erasmus MC Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. f.prince@erasmusmc.nl
authors.forename: Femke H M
authors.initials: FH
authors.lastname: Prince
authors.forename: Esther W
authors.initials: EW
authors.lastname: de Bekker-Grob
authors.forename: Marinka
authors.initials: M
authors.lastname: Twilt
authors.forename: Marion A J
authors.initials: MA
authors.lastname: van Rossum
authors.forename: Esther P A H
authors.initials: EP
authors.lastname: Hoppenreijs
authors.forename: Rebecca
authors.initials: R
authors.lastname: ten Cate
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Koopman-Keemink
authors.forename: Simone L
authors.initials: SL
authors.lastname: Gorter
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
authors.forename: Lisette W A
authors.initials: LW
authors.lastname: van Suijlekom-Smit
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D002648:Child; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D000068800:Etanercept; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D009426:Netherlands; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012042:Registries
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept