AB1148 ECONOMIC BENEFIT FROM IMPROVEMENTS IN HEALTH-RELATED QUALITY OF LIFE WITH UPADACITINIB AND COMPARISONS WITH TOFACITINIB AND METHOTREXATE IN PATIENTS WITH MODERATELY TO SEVERELY ACTIVE RHEUMATOID ARTHRITIS

Abstract

Background:Rheumatoid arthritis (RA) is a chronic, debilitating autoimmune disease and is associated with high direct medical costs. Treatment of RA with disease-modifying anti-rheumatic drugs (DMARDs) can improve patients’ health-related quality of life (HRQOL) and has the potential to reduce direct medical costs associated with RA. Treatment with janus kinase inhibitors, such as upadacitinib (UPA), has shown improvements in HRQOL in patients with RA [1].Objectives:To estimate the economic benefit from improvements in HRQOL and to compare estimated direct medical costs between: (1) UPA and tofacitinib (TOFA) and (2) UPA monotherapy and methotrexate (MTX) monotherapy in patients with RA.Methods:This economic analysis used individual patient-level data from 2 randomized clinical trials (RCTs) of UPA (SELECT-NEXT and SELECT-MONO) and published aggregate data from 1 RCT of TOFA (ORAL-Standard) in patients with moderate to severe RA that collected repeated measurements of HRQOL based on the Short Form 36 Health Survey (SF-36). Estimated direct medical costs per patient per month (PPPM) for UPA 15mg once daily (QD) and MTX were estimated based on observed SF-36 Physical (PCS) and Mental Component Summary (MCS) scores in the SELECT RCTs using a published regression algorithm [2]. Direct medical costs PPPM for TOFA 5mg twice daily (BID) were estimated from Rendas-Baum, et al [3], which applied the same regression algorithm to SF-36 PCS and MCS scores observed in the ORAL-Standard RCT. Resulting estimates of direct medical costs PPPM in the short-term (12–14 weeks) and long-term (48 weeks) were compared between UPA and TOFA and between UPA and MTX. Costs were inflation-adjusted to 2018 US dollars. Bootstrapping was used to generate 95% confidence intervals (CI).Results:Over 12 weeks, estimated direct medical costs PPPM were $186 lower (95% CI: $21, $364) in patients treated with UPA compared with those treated with TOFA. Estimated long-term medical costs PPPM at Weeks 24 and 48 (Figure 1) and cumulative costs over the entire 48-week period (difference: $1,452; 95% CI: $906, $2,086; Table) were significantly lower for UPA than for TOFA. Over 14 weeks, estimated direct medical costs PPPM were $370 lower (95% CI: $147, $575) in patients treated with UPA monotherapy compared with those treated with MTX alone. Estimated long-term direct medical costs at Week 48 (Figure 2) and cumulative costs over the entire 48-week period (difference: $2,120; 95% CI: $1,398, $2,861; Table) were significantly lower for UPA monotherapy compared with MTX alone.Conclusion:Based on improvements in HRQOL in the short-term and long-term, UPA 15mg QD was associated with significantly lower direct medical costs than TOFA 5mg BID in patients with active RA. UPA 15mg QD monotherapy was associated with significantly lower direct medical costs than MTX monotherapy in patients with active RA. These results provide evidence of the economic benefits of UPA as a novel treatment for moderate to severe RA.