Currie, G.

Grazziotin Lago, L.

IJzerman, M.J.

Kip, M.

Marshall, D.

Schreijer, M.A.

Swart, J.F.

Twilt, M.

van Royen, A.

English

University of Twente Research Information

Analysing the prescribing patterns and costs of drug treatment in juvenile idiopathic arthritis in the NetherlandsMaud A. Schreijer1, Michelle M.A. Kip1, Deborah A. Marshall2, Gillian Currie3, Luiza Grazziotin Lago2, Marinka Twilt4, Susanne M. Benseler4, Sytze de Roock5, Annet van Royen5, Joost F. Swart5, Sebastiaan J. Vastert5, Nico Wulffraat5, Rae S.M. Yeung6, Maarten J. IJzerman1, on behalf of the UCAN CAN-DU health economics working group* of the UCAN CAN-DU project1Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands, 2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada, 3Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada, 4Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada, 5Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands, 6Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.Objectives• JIA is the most common chronic rheumatologic disease in childhood• Pharmacological treatment is crucial to achieve control of the disease• Aims:     o Describe different lines of treatment for JIA patients o Quantify the accompanying impact on drug costs.Data analysed: • Retrospective cohort of 884 JIA patients (0-18 years), treated in the Wilhelmina Children’s Hospital (NL), between 04/2011 and 04/2019. o Including: data on the type, frequency and duration of medication prescribed.• Prescribed doses and accompanying cost prices were retrieved from the Dutch Pharmacotherapeutic Compass and the Dutch paediatric formulary.Results• Number of different (combinations of) drugs prescribed:o 20 drugs (or combinations) as first-line treatmento 35 drugs (or combinations) as second-line treatment• Oral methotrexate (MTX) was the most commonly prescribed first-line treatment (56.7% of patients, figure 1), compared with 39.1% in second-line (including combination therapy). o In systemic JIA, anakinra was the most common first line treatment (figure 2).• On average, patients receive 2.3 lines of treatment during an average 4.4 year follow-up period. • The average annual costs/patient range from €93 for undifferentiated JIA to €8,676 for systemic JIA. o Biologics represent 84.7% of total drug costs o Canakinumab was the most expensiveConclusion and discussion• Pharmacological treatment of JIA is complex and warrants an individualized approach. • Systemic JIA represents the subgroup with the highest medication costs, attributable to the use of biologics, in particular canakinumab.Table 1. Number of patients and costs of different types of medication for JIA (IA = intra-articular, pers. = persistent)Results*Health Economics Working Group: Gouke Bonsel, Brian M. Feldman, Esther Hoppenreijs, Bianca Lang, Claire LeBlanc, Karine Toupin-April, Philomine van PeltMethodsFigure 1. Sunburst diagram visualizing 1stand 2nd line treatment in JIA (excluding systemic JIA). Adal. = adalimumabJIA subtype N (%)Biologic DMARDsNon-biologic DMARDs SteroidsIA injec-tions Other TotalSystemic 87 (9.8%) € 8,546 € 26 € 41 € 2 € 61 € 8,676Polyarticular RF + 38 (4.3%) € 4,634 € 211 € 38 € 13 € 39 € 4,934Extended oligoarticular 84 (9.5%) € 2,818 € 197 € 13 € 20 € 277 € 3,326Enthesitis related 75 (8.5%) € 3,064 € 70 € 0 € 5 € 88 € 3,226Polyarticular RF - 167 (18.9%) € 2,648 € 143 € 10 € 11 € 214 € 3,026Oligoarticular pers. ANA + 168 (19.0%) € 1,384 € 90 € 13 € 29 € 1,306 € 2,821Psoriatic arthritis 34 (3.8%) € 2,295 € 67 € 1 € 13 € 62 € 2,438Uveitis 57 (6.4%) € 731 € 129 € 3 € 1 € 1,296 € 2,159Oligoarticular pers. ANA - 164 (18.6%) € 711 € 67 € 0 € 21 € 197 € 996Undifferentiated 10 (1.1%) € 0 € 6 € 0 € 26 € 61 € 93Figure 2. Sunburst diagram visualizing 1stand 2nd line treatment    in systemic JIAMTX oralQuestions or more information?m.m.a.kip@utwente.nl www.ucancandu.com

Analysing prescribing patterns and costs of drug treatment in juvenile idiopathic arthritis in the Netherlands

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Analysing prescribing patterns and costs of drug treatment in juvenile idiopathic arthritis in the Netherlands

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