Comparative Cost-Effectiveness of Tofacitinib With Continuing Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs for Active Rheumatoid Arthritis in South Korea

• Published in: Rheumatology and therapy. Vol. 8; no. 1; pp. 395 - 409
• Main Authors: Ha, So-Young, Shim, Yoon-Bo, Lee, Min-Young, Koo, Bon-San, Kim, Jae-Hoon, Jeon, Ja-Young, Yoo, Hyun-Jeong, Kim, Young-Joo, Shin, Ju-Young, Park, Mi-Hai
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.03.2021; Springer Nature B.V
• Subjects: Autoimmune diseases; Cost analysis; Family Medicine; General Practice; Internal Medicine; Markov chains; Medicine; Medicine & Public Health; Original Research; Orthopedics; Quality of Life Research; Rheumatoid arthritis; Rheumatology; Sensitivity analysis; United States > US; Quality-adjusted life-years; Anti-rheumatic agents; Rheumatoid arthritis; Cost–benefit analysis
• ISSN: 2198-6576; 2198-6584
• DOI: 10.1007/s40744-021-00278-z

Introduction The objective of this study was to evaluate the cost-effectiveness of initiating treatment with tofacitinib and subsequently incorporating it into a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) treatment sequence and to compare the cost-effectiveness of this sequence with that of continuing csDMARDs alone in patients with active rheumatoid arthritis (RA). Methods A cohort-based Markov model was used to evaluate the cost-effectiveness of two tofacitinib treatment sequences compared with that of continuing the csDMARD treatment sequence over a lifetime. Of the two tofacitinib sequences, the first consisted of initial tofacitinib treatment followed by biologic DMARDs (bDMARDs) and the second consisted of csDMARD treatments followed by tofacitinib. A third treatment sequence, continuing the csDMARD treatment sequence before starting bDMARDs, was used as a comparator. Efficacy was assessed using the American College of Rheumatology (ACR) response rates (ACR 20, ACR 50, and ACR 70) after 6 months, which were converted to changes in the health assessment questionnaire-disability index (HAQ-DI) score. Utility was estimated by mapping from the HAQ-DI score, costs were analyzed from a Korean societal perspective, and outcomes were considered in terms of quality-adjusted life-years (QALYs). One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model. Results The incremental cost-effectiveness ratios over a lifetime for starting with tofacitinib and incorporating tofacitinib into the csDMARD treatment sequence versus continuing csDMARDs only were US$14,537 per QALY and US$7,086 per QALY, respectively. One-way sensitivity analysis and probabilistic sensitivity analysis confirmed the robustness of these results. Conclusion Starting with tofacitinib and incorporating it into a csDMARDs treatment sequence is cost-effective compared to continuing csDMARDs alone in patients with RA.