PMS47 - COST-EFFECTIVENESS OF TOFACITINIB COMPARED WITH ADALIMUMAB IN THE TREATMENT OF MODERATE TO SEVERE RHEUMATOID ARTHRITIS IN IRAN

Abstract

Tofacitinib (TFC) is an oral Janus kinase inhibitor for the treatment of moderately to severely active rheumatoid arthritis (RA). This study was aimed to estimate the cost-effectiveness of tofacitinib versus adalimumab (ADA) from a payer perspective in RA patients for whom with inadequate response or intolerance to methotrexate (MTX) in Iran. A cohort-based Markov model was developed using TreeAge pro 2018 to evaluate the lifetime cost-effectiveness of TFC (5 mg twice a day) plus MTX versus ADA (40 mg every other week) plus MTX using efficacy results from a phase 3b/4 head-to-head study (ORAL Strategy). Response to treatment was modeled as American College of Rheumatology (ACR) 20/50/70 response. ACR responses produce changes in the Health Assessment Questionnaire-Disability Index (HAQ-DI) score. To estimate quality-adjusted life-years (QALYs), the HAQ-DI score was mapped to utility. Costs were reported in 2018 U.S. dollars and comprised medications, hospitalization, outpatient visits, administration, dispensing, monitoring, palliative therapy, and treatment for adverse events. Cost-effectiveness result was presented in terms of incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses (PSA) were conducted to explore the uncertainty of model parameters and assumptions. TFC compared to ADA was associated with higher cost (US$ 29,506 vs US$ 29,340) and higher efficacy (6.05 QALYs vs 5.99 QALYs) throughout the lifetime of patients with RA and MTX inadequate response, resulting in an ICER of US$ 2,618 per QALY. One-way sensitivity analysis indicated that the result is sensitive to TFC and ADA acquisition cost. PSA demonstrated that TFC had a 57% probability of being cost effective at the willingness to pay threshold of Iran 1 GDP/capita (US$ 5400) compared to ADA. TFC is projected to be cost-effective compared to ADA in patients with moderate to severe RA for whom methotrexate is not appropriate, from Iranian payer perspective.