University of Twente Student Theses
Real world prescription patterns and costs of drug treatment in juvenile idiopathic arthritis in the Netherlands
Schreijer, M.A. (2019) Real world prescription patterns and costs of drug treatment in juvenile idiopathic arthritis in the Netherlands.
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| Abstract: | Objective: Juvenile idiopathic arthritis (JIA) represents seven forms of chronic arthritis in children. Inadequately treated, it may result in lifelong disability. Treatment of JIA usually involves methotrexate (MTX) as 1 st line therapy, and (more costly) biological disease-modifying anti-rheumatic drugs (DMARDs) as second-line treatment. However, in systemic JIA, biological DMARDs are used as 1 st line treatment. To achieve adequate disease control, many different combinations and sequences of medication may be necessary. This study aims to describe different lines of treatment for JIA patients and to quantify the accompanying impact on drug costs. Methods: A cohort of 884 JIA patients (0-18 years), treated in the Wilhelmina Children’s Hospital (the Netherlands), between 1 April 2011 and 9 April 2019 was analysed. Data on the type, frequency and duration of medication prescribed to these patients were retrieved from the hospital administrative system. Prescribed doses and accompanying cost prices were retrieved from the Dutch paediatric formulary and the Dutch Pharmacotherapeutic Compass, to calculate the average annual costs of medication per patient. Results: Twenty different (combinations of) drugs were used as 1 st line treatment, compared with 35 as 2 nd line treatment. Oral MTX was the most commonly prescribed 1 st line treatment (56.7% of patients), compared with 39.1% in second-line (including combination therapies). 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. This difference was mainly attributable to the high costs of biologics (84.7% of total drug costs). Canakinumab was only used among systemic JIA patients and by far the most expensive, costing on average €60,156/patient/year over the entire follow-up period. Conclusion: Pharmacological treatment of JIA is complex and warrants an individualized approach. Systemic JIA represents the subgroup with the highest medication costs, which is attributable to 1) the use of biological DMARDs in the 1st line, 2) the use of canakinumab, which is restricted to systemic JIA patients. |
| Item Type: | Essay (Master) |
| Faculty: | TNW: Science and Technology |
| Subject: | 44 medicine, 83 economics |
| Programme: | Health Sciences MSc (66851) |
| Link to this item: | https://purl.utwente.nl/essays/78803 |
| Export this item as: | BibTeX EndNote HTML Citation Reference Manager |
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