title: The financial burden of juvenile idiopathic arthritis: a Nova Scotia experience.
abstract: BACKGROUND
  Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic illness. There is little published data on the financial burden of this illness. The primary objective of this study was to determine the annual costs borne by families of a child with JIA living in Nova Scotia (NS).
  
  
  METHODS
  All families in NS with a child followed in the Pediatric Rheumatology Clinic at the Izaak Walton Killam Health Centre (IWK) in 2009 were mailed a self-report questionnaire. The questionnaire evaluated disease related costs, gross household income and perceived financial burden. Dillman's method was used to optimize return rates. Descriptive statistics were used to summarize results. Spearman's correlation coefficient was used to assess the relationship of distance from the IWK and cost. The Mann-Whitney U test was used to compare median costs between groups.
  
  
  RESULTS
  Of 172 possible respondents, we received 54 completed questionnaires and 11 blank questionnaires (overall response rate 31.4%). Approximately one third (35.9%) of parents rated the financial burden as moderate or large and 36% rated financial resources available as poor. The median annual total cost per patient was $619.50 CAD (range 0, $5535) which was a median 0.7% (range 0, 37%) of gross household incomes. The largest expense for families was visit related costs. There was not a significant relationship between total annual costs and distance from the IWK (rs = 0.18, P = 0.2). Families of a child with oligoarthritis had significantly lower costs than the families of a child with another subtype of JIA ($359.00 CAD vs. $877.00 CAD, P = 0.02).
  
  
  CONCLUSIONS
  The costs associated with having a child with JIA in NS are on average modest, but may be considerable for some families. Oligoarticular JIA is associated with smaller costs. Many families perceive the burden to be at least moderate and the availability of financial resources to be poor. Supports should be targeted to those families most in need.
authors.affiliation: IWK Health Centre, Halifax, Nova Scotia, Canada. adam.huber@iwk.nshealth.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ens
authors.forename: Bianca
authors.initials: B
authors.lastname: Lang
authors.forename: Suzanne
authors.initials: S
authors.lastname: Ramsey
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stringer
authors.forename: Adam M
authors.initials: AM
authors.lastname: Huber