Economic evaluation of a trial exploring the effects of a web-based support tool for parents of children with Juvenile Idiopathic Arthritis.

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 randomised controlled 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 at 12 months follow up. Costs were calculated for healthcare usage using a UK NHS economic perspective. Some data was also 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
At 4 months, the intervention arm showed improved Pediatric Inventory for Parents (PIP) scores with a mean difference between trial arms in the dimensions of frequency and difficulty scores of 1.5 and 3.6 respectively. At 12 months, the mean difference between trial arms in frequency and difficulty scores were 0.35 and 0.39, again 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 to 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.

At both 4 month and 12 month follow up, the majority of costs associated with health service use were found to belong to secondary care for both arms.
Cost data was further analysed in combination with effectiveness data from the Pediatric Inventory for Parents measure. The probability of being cost effective ranged between 49% and 54%.

Conclusion
The WebParC online intervention led to reductions in primary and secondary healthcare resource use that translated into reduced 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.

Keywords
Juvenile arthritis, cost effectiveness, parent support, telehealth, economic evaluation.

Key Messages
1. This study reports on a relatively low-cost, online digital intervention for reducing parental stress.
2. Cost savings within the National Health Service were achieved particularly within rheumatology services.
3. Further reductions in parental stress and online support operating costs could extend cost effectiveness.