Background
Juvenile Idiopathic Arthritis (JIA) requires complex care that generate elevated costs, which results in a high economic impact for the family. The aim of this systematic review was to collect and cluster the information currently available on healthcare costs associated with JIA after the introduction of biological therapies.
Methods
We comprehensively searched in MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Databases for studies from January 2000 to March 2021. Reviewers working independently and in duplicate appraised the quality and included primary studies that report total, direct and/or indirect costs related to JIA for at least one year. The costs were converted to United States dollars and an inflationary adjustment was made.
Results
We found 18 eligible studies including data from 6,540 patients. Total costs were reported in 10 articles, ranging from $310 USD to $44,832 USD annually. Direct costs were reported in 16 articles ($193 USD to $32,446 USD), showing a proportion of 55 to 98 % of total costs. Those costs were mostly related to medications and medical appointments. Six studies reported indirect costs ($117 USD to $12,385 USD). Four studies reported costs according to JIA category observing the highest in polyarticular JIA. Total and direct costs increased up to three times after biological therapy initiation. A high risk of reporting bias and inconsistency of the methodology used were found.
Conclusion
The costs of JIA are substantial, and the highest are derived from medication and medical appointments. Indirect costs of JIA are underrepresented in costs analysis.
Purpose. Reports have concluded that platelet-rich plasma (PRP) is an
effective and safe biological approach to treating knee osteoarthritis
(OA). However, the efficacy of PRP in advanced stages of the disease is
not entirely clear. The purpose of this study was to evaluate whether
the use of PRP would be as effective in studies with early-moderate knee
OA patients compared to studies including patients with end-stage OA
based on the Kellgren-Lawrence classification. Methods. A comprehensive
search in MEDLINE, EMBASE, Scopus, and Web of Science was conducted to
identify randomized controlled trials (RCTs) comparing the effect of PRP
injections versus other intra-articular treatments on pain and
functionality. A meta-analysis was conducted using a random-effects
model and the generic inverse variance method. Results. We included 31
clinical trials that reported data of 2705 subjects. Meta-analysis
revealed an overall significant improvement of both pain (MD, -1.05
[95% CI -1.41 to -0.68]; I2 = 86%; P = < 0.00001) and
function (SMD, -0.99 [95% CI -1.34, to -0.65]; I2 = 94%; P =
< 0.00001), favoring PRP. Subanalysis for pain and functional
improvement showed significant pain relief in studies with 1-3 and 1-4
Kellgren-Lawrence OA stages, and a significant functional improvement in
studies with 1-2, 1-3, and 1-4 knee OA stages, favoring PRP. Conclusion.
Our results indicate that including patients with advanced knee OA does
not seem to affect the outcomes of clinical trials in which the efficacy
of PRP in knee OA is assessed.
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