OBJECTIVES: Systemic juvenile idiopathic arthritis (sJIA) is a rare, complex autoinflammatory disease with substantial morbidity. Since the turn of the century, biologic agents (such as anakinra) have been successfully used to treat patients internationally, but their usage in some regions is limited to those that have failed to achieve clinically-inactive disease with corticosteroids and conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Use of anakinra in the first line leads to better clinical outcomes, but longer-term costs for this strategy have not been established. This study aims to compare the economic implications of alternative treatment strategies with anakinra for patients with sJIA.

METHODS: Data for patients treated with first-line anakinra were identified from a single-centre, prospective study conducted in the Netherlands and compared to a combination of published clinical trials and economic evaluation information, as well as clinical expert input to facilitate a comparison to later-line anakinra (i.e. following corticosteroids + csDMARDs). Costs were estimated for product acquisition and medical resource use (MRU), including planned outpatient visits and unplanned hospital admissions. Total costs (in Euros) over a 5-year horizon were compared.

RESULTS: Total 5-year product acquisition costs for the first-line anakinra strategy were €24,021, versus €20,471 for later-line anakinra. The corresponding MRU costs were €19,197 (first-line) versus €25,425 (later-line). Overall 5-year costs (product acquisition and MRU) were lower for the first-line strategy (€43,218 versus €45,896).

CONCLUSIONS: A comparison of economic outcomes in the management of sJIA with anakinra is challenging, yet the findings of this study support the expectation that earlier use may lead to cost savings through reduced medical expenditure. Further research is required to fully establish the differences in costs associated with alternative treatment strategies in sJIA, including costs related to the avoidance of additional downstream costs, such as steroid-related complications, osteoarthritis, and macrophage activation syndrome.