Costs of hospital-associated care for patients with juvenile idiopathic arthritis in the Dutch healthcare system.

OBJECTIVE: This study aims to 1) quantify costs of hospital-associated care for juvenile idiopathic arthritis (JIA), 2) provide insights in patient-level variation in costs, and 3) investigate costs over time from the moment of JIA diagnosis. Results are reported for all JIA patients in general and by subtype.

METHODS: This study is a single-center, retrospective analysis of prospective data from electronic medical records of children with JIA, aged 0-18 years between 1 April 2011 and 31 March 2019. Patient characteristics (age, gender, JIA subtype), and hospital-based resource use (consultations, medication, radiology procedures, laboratory testing, surgeries, emergency department (ED) visits, hospital stays) were extracted and analyzed. Unit prices were obtained from Dutch reimbursement lists, pharmaceutical list prices, and hospital list prices.

RESULTS: The analysis included 691 patients. Mean total costs of hospital care were €3,784/patient/year, of which €2,103 (55.6%) was attributable to medication. Other costs involved pediatric rheumatologist visits (€633/patient/year, 16.7%), hospital stays (€439/patient/year, 11.6%), other within-hospital specialist visits (€324/patient/year, 8.6%), radiology procedures (€119/patient/year, 3.1%), laboratory tests (€114/patient/year, 3.0%), surgeries (€46/patient/year, 1.2%) and ED visits (€6/patient/year, 0.2%). Mean annual total costs varied between JIA subtypes and between individuals, and were the highest for systemic JIA (€7,772/patient/year). Over the treatment course, costs were the highest in the first month after JIA diagnosis.

CONCLUSION: Hospital care costs of JIA vary substantially between individuals, between subtypes, and over the treatment course. The highest annual costs were for systemic JIA, primarily attributable to medication (i.e. biologicals). Costs of other hospital-associated care were comparable regardless of subtype.