{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:49:12Z","timestamp":1782488952028,"version":"3.54.5"},"reference-count":41,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T00:00:00Z","timestamp":1600128000000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"This work was supported by Bureau of Drug Control, Thai Food and Drug Administration","award":["504\/2561"],"award-info":[{"award-number":["504\/2561"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,7,19]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to analyse the cost\u2013utility and budget impact of adding tocilizumab to the standard treatment for patients with refractory systemic juvenile idiopathic arthritis (sJIA) in Thailand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Economic evaluation using a decision-analytical model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Thailand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients with refractory sJIA who were \u22652 years old.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The use of tocilizumab as an add-on therapy to standard treatment was compared with standard treatment alone. A simulated health state transition model was used to estimate the lifetime costs and health outcomes from a societal perspective. Direct medical costs were collected from tertiary hospital databases while direct non-medical costs were derived from interviews. Health-related quality of life (QoL) was measured using the proxy version of three-level EuroQol five-dimensional questionnaire (EQ-5D-3L). Future costs and outcomes were discounted at an annual rate of 3%. The base case population was patients aged 9.41 years old at refractory disease onset. The results were reported as incremental cost-effectiveness ratios (ICER) in US dollar (USD). One-way and probabilistic sensitivity analysis were conducted to investigate parameter uncertainty. The 5-year budget impact was estimated from a governmental perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ICER of standard treatment plus tocilizumab was US$35\u2009799 per quality-adjusted life-year (QALY) gained compared with standard treatment alone, which was not cost-effective at the threshold of US$5128 per QALY gained. The estimated 5\u2009years budget impact was approximately US$4.8\u2009million.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of standard treatment plus tocilizumab was not cost-effective in the Thai context, which has limited data. However, there is currently no second-line treatment for refractory sJIA in the Thai National List of Essential Medicines; thus, patients must receive higher doses of standard treatment which can cause many side effects. In contrast, tocilizumab showed obvious efficacy in clinical trials in improving treatment response and QoL. Therefore, the price of tocilizumab should be negotiated to reduce the financial impact on the healthcare system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-037588","type":"journal-article","created":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T17:31:30Z","timestamp":1600191090000},"page":"e037588","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Cost\u2013utility and budget impact analysis of tocilizumab for the treatment of refractory systemic juvenile idiopathic arthritis in Thailand"],"prefix":"10.1136","volume":"10","author":[{"given":"Nitichen","family":"Kittiratchakool","sequence":"first","affiliation":[{"name":"Health Intervention and Technology Assessment Program, Nonthaburi, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Disorn","family":"Kulpokin","sequence":"additional","affiliation":[{"name":"Health Intervention and Technology Assessment Program, Nonthaburi, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chonticha","family":"Chanjam","sequence":"additional","affiliation":[{"name":"Health Intervention and Technology Assessment Program, Nonthaburi, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soamarat","family":"Vilaiyuk","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirirat","family":"Charuvanij","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gun","family":"Phongsamart","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parichat","family":"Khaosut","sequence":"additional","affiliation":[{"name":"Pediatric Allergy & Clinical Immunology Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manasita","family":"Tanya","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Khon Kaen Hospital, Khon Kaen, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratanavadee","family":"Nanagara","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sira","family":"Nantapaisarn","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9584-0293","authenticated-orcid":false,"given":"Pattara","family":"Leelahavarong","sequence":"additional","affiliation":[{"name":"Health Intervention and Technology Assessment Program, Nonthaburi, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,15]]},"reference":[{"key":"2026062608023583000_10.9.e037588.1","first-page":"390","article-title":"International League of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001","volume":"31","author":"Petty","year":"2004","journal-title":"J Rheumatol"},{"key":"2026062608023583000_10.9.e037588.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60244-4"},{"key":"2026062608023583000_10.9.e037588.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2018.04.005"},{"key":"2026062608023583000_10.9.e037588.4","unstructured":"Firestein GS , Budd RC , Gabriel SE , et al . 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