{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:17:50Z","timestamp":1786976270381,"version":"build-2736575974"},"reference-count":50,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2016,10,21]],"date-time":"2016-10-21T00:00:00Z","timestamp":1477008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Ontario Ministry of Health and Long-Term Care Drug Innovation Fund and by the Hospital for Sick Children"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The optimal timing of biologic agent treatment in polyarticular juvenile idiopathic arthritis (JIA) is unknown. This study evaluated the costs and outcomes of first\u2010line treatment with etanercept (ETN), an anti\u2013tumor necrosis factor (anti\u2010TNF) agent, compared with step\u2010wise therapy in JIA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We compared 2 strategies: methotrexate (MTX) plus ETN as first\u2010line therapy (ETN\u2010first) and MTX monotherapy followed by ETN (ETN\u2010second), using a cohort state\u2010transition model of newly diagnosed JIA patients. The model's time horizon was 5 years, and the perspective was that of the Canadian health care system. The base case patient was 11 years old, weighed 40 kg, and had 5 or more active joints. Direct costs were calculated and discounted at a rate of 3% per year. Outcomes were expressed as quality\u2010adjusted life years (QALYs). Scenario analyses varied multiple parameters simultaneously to model more severely and more mildly affected patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ETN\u2010first, compared to ETN\u2010second, yielded a discounted incremental cost of $16,893 (95% confidence interval [95% CI] 9,348\u201325,310), incremental QALY of 0.19 (95% CI 0.08\u20130.32), and an incremental cost\u2010effectiveness ratio of $88,815 per QALY gained. The results were sensitive to the cost of ETN, the time horizon of the model, and estimates of the efficacy of the first\u2010line therapies. The cost per QALY for treating patients with severe JIA was $33,960.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>First\u2010line therapy of ETN and MTX is relatively expensive compared to MTX alone, but may be economically attractive for more severely affected patients. More research is needed regarding the efficacy of first\u2010line anti\u2010TNF agents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.22903","type":"journal-article","created":{"date-parts":[[2016,4,10]],"date-time":"2016-04-10T08:35:59Z","timestamp":1460277359000},"page":"1803-1811","source":"Crossref","is-referenced-by-count":19,"title":["Cost\u2010Effectiveness Analysis of First\u2010Line Treatment With Biologic Agents in Polyarticular Juvenile Idiopathic Arthritis"],"prefix":"10.1002","volume":"68","author":[{"given":"Nadia J.","family":"Luca","sequence":"first","affiliation":[{"name":"Alberta Children's Hospital and University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather F.","family":"Burnett","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy J.","family":"Ungar","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myla E.","family":"Moretti","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Beukelman","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Feldman","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwen","family":"Schwartz","sequence":"additional","affiliation":[{"name":"St. Michael's Hospital Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Bayoumi","sequence":"additional","affiliation":[{"name":"St. Michael's Hospital Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,10,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60363-8"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20044"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22463"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20337"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20460"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.143347"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.20288"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2012.633509"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780195108248.001.0001"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2012.10.006"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400703"},{"key":"e_1_2_6_13_1","first-page":"2290","article-title":"Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis","volume":"31","author":"Wallace CA","year":"2004","journal-title":"J Rheumatol"},{"key":"e_1_2_6_14_1","unstructured":"Program OPDB. 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