title: Parents' willingness to pay for biologic treatments in juvenile idiopathic arthritis.
abstract: BACKGROUND
  Biologic therapies are considered the standard of care for children with the most severe forms of juvenile idiopathic arthritis (JIA). Inconsistent and inadequate drug coverage, however, prevents many children from receiving timely and equitable access to the best treatment.
  
  
  OBJECTIVE
  The objective of this study was to evaluate parents' willingness to pay (WTP) for biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs) used to treat JIA.
  
  
  METHODS
  Utility weights from a discrete choice experiment were used to estimate the WTP for treatment characteristics including child-reported pain, participation in daily activities, side effects, days missed from school, drug treatment, and cost. Conditional logit regression was used to estimate utilities for each attribute level, and expected compensating variation was used to estimate the WTP. Bootstrapping was used to generate 95% confidence intervals for all WTP estimates.
  
  
  RESULTS
  Parents had the highest marginal WTP for improved participation in daily activities and pain relief followed by the elimination of side effects of treatment. Parents were willing to pay $2080 (95% confidence interval $698-$4065) more for biologic DMARDs than for nonbiologic DMARDs if the biologic DMARD was more effective.
  
  
  CONCLUSIONS
  Parents' WTP indicates their preference for treatments that reduce pain and improve daily functioning without side effects by estimating the monetary equivalent of utility for drug treatments in JIA. In addition to evidence of safety and efficacy, assessments of parents' preferences provide a broader perspective to decision makers by helping them understand the aspects of drug treatments in JIA that are most valued by families.
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Heather F
authors.initials: HF
authors.lastname: Burnett
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: wendy.ungar@sickkids.ca.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Ungar
authors.affiliation: Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Regier
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Rheumatology, The Hospital for Sick Children, and Departments of Pediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada; The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
authors.affiliation: Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Fiona A
authors.initials: FA
authors.lastname: Miller
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001688:Biological Products / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D002755:Choice Behavior; D003657:Decision Making; D006801:Humans; D018803:Models, Economic; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: biologics; discrete choice experiment; juvenile idiopathic arthritis; willingness to pay