Background Rheumatoid arthritis (RA) is a chronic progressive inflammatory condition that is associated with significant economic burden. Tofacitinib is an oral Janus kinase inhibitor indicated in the US for treatment of moderate to severe RA. Given the limited resource and multiplicity of treatment options, economic evaluation of alternate treatment strategies could inform formulary decisions in the US.
Objectives The objective of this analysis is to estimate incremental cost effectiveness ratios (ICERs) of tofacitinib after failure of methotrexate (MTX) in a sequence of treatments compared with a similar sequence without tofacitinib from a third-party-payer's perspective in the US.
Methods The model was designed to estimate the costs and outcomes of treating RA with a pre-specified “treatment sequence” (MTX, tofacitinib, adalimumab, abatacept, tocilizumab and rituximab, in that order) vs a “comparator sequence” (MTX, etanercept, adalimumab, abatacept, tocilizumab and rituximab, in that order). Alternative sequences of treatment were also considered but not reported here. Efficacy was measured using Health Assessment Questionnaire (HAQ), and compared using results of a mixed treatment comparison and data from long-term extension trials. Adverse events data were taken from published meta-analyses, trial data on tofacitinib and identified relevant comparators. Patient characteristics were based on averages from tofacitinib clinical trials (NCT00856544, ORAL Sync; NCT00847613, ORAL Scan; NCT00853385, ORAL Standard). Costs related to RA were taken from published data which mapped HAQ onto healthcare resource utilisation in US RA patients. Indirect costs were not considered.
Results From the perspective of the US third-party payer, the predicted lifetime cost of “treatment sequence” including tofacitinib had costs of $509,047 vs $546,860 for “comparator sequence” without tofacitinib. The “treatment sequence” with tofacitinib also resulted in an additional 0.11 in quality-adjusted life years (QALYs), vs “comparator sequence” without tofacitinib. Therefore, “treatment sequence” with tofacitinib is dominant vs alternative sequence without tofacitinib. Probabilistic sensitivity analysis suggests that the probability of tofacitinib being cost-effective as a second-line therapy is 64.0% at a threshold of $100,000.
Conclusions Our model suggests that inclusion of tofacitinib as second-line therapy following methotrexate failure is a cost-effective alternative vs a “comparator sequence” without tofacitinib. Sensitivity analysis reiterates the robustness of results and cost-effectiveness of a sequence of treatment with tofacitinib. A comparison of alternate sequences of treatment resulted in comparable findings.
Acknowledgements This study was funded by Pfizer Inc.
Disclosure of Interest L. Claxton Consultant for: Pfizer Inc., M. Taylor Consultant for: Pfizer Inc., D. Moynagh Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., D. Gruben Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., G. Wallenstein Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., A. Singh Shareholder of: Pfizer Inc., Employee of: Pfizer Inc.