Economic evaluation of a trial exploring the effects of a web-based support tool for parents of children with juvenile idiopathic arthritis

Chris Flood; Shashivadan P Hirani; Kathleen Mulligan; Jo Taylor; Sally Harris; Lucy R Wedderburn; Stanton P Newman

doi:10.1093/rheumatology/keae188

Economic evaluation of a trial exploring the effects of a web-based support tool for parents of children with juvenile idiopathic arthritis

Rheumatology (Oxford). 2024 Mar 22:keae188. doi: 10.1093/rheumatology/keae188. Online ahead of print.

Authors

Chris Flood^{1

2}, Shashivadan P Hirani², Kathleen Mulligan^{2

3}, Jo Taylor², Sally Harris⁴, Lucy R Wedderburn^{5

6

7}, Stanton P Newman²

Affiliations

¹ Institute of Health and Social Care, London South Bank University, London, UK.
² Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom.
³ East London NHS Foundation Trust, United Kingdom, London.
⁴ University Hospitals Sussex NHS Trust, Brighton, United Kingdom.
⁵ University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
⁶ Centre for Adolescent Rheumatology Versus Arthritis at University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
⁷ National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital, London, United Kingdom.

PMID: 38519117
DOI: 10.1093/rheumatology/keae188

Abstract

Objective: To explore the cost-effectiveness of a web-based support tool for parents of children with Juvenile Idiopathic Arthritis.

Methods: A multi-centred randomised controlled trial was conducted in paediatric rheumatology centres in England. The WebParC intervention consisted of online information about JIA and its treatment and a toolkit using cognitive-behavioural therapy principles to support parents manage their child's JIA. An economic evaluation was performed alongside the trial involving 220 parents. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress, with two dimensions; difficulty and frequency. These measures along with costs were assessed post intervention at 4 months and 12 months. Costs were calculated for healthcare usage using a UK NHS economic perspective. Data was collected and analysed on the impact of caring costs on families. Uncertainty around cost effectiveness was explored using bootstrapping and cost-effectiveness acceptability curves.

Results: The intervention arm showed improved average Pediatric Inventory for Parents scores for the dimensions of frequency and difficulty, of 1.5 and 3.6 respectively at 4 months and. 0.35 and 0.39 at 12 months, representing improved PIP scores for the intervention arm. At both 4 and 12 month follow up the average total cost per case was higher in the control group when compared with the intervention arm with mean differences of £360 (95% CI £29.6 to £691) at 4 months and £203 (95% CI £16 to £390) at 12 months. The probability of the intervention being cost effective ranged between 49% and 54%.

Conclusion: The WebParC intervention led to reductions in primary and secondary healthcare resource use and costs at 4 and 12 months. The intervention demonstrated particular savings for rheumatology services at both follow ups. Future economies of scale could be realised by health providers with increased opportunities for cost effectiveness over time.

Trial registration: ISRCTN, ISRCTN13159730.

Keywords: Juvenile arthritis; cost effectiveness; economic evaluation; parent support; telehealth.