Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis

a cost-effectiveness analysis compared with adalimumab in Taiwan

Der Yuan Chen, Ping Ning Hsu, Chao Hsiun Tang, Lindsay Claxton, Satish Valluri, Robert A. Gerber

Research output: Contribution to journalArticle

Abstract

Aims: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This analysis investigated the cost-effectiveness of the second-line treatment with tofacitinib, compared with adalimumab, both plus methotrexate (MTX), in patients with moderate-to-severe RA and an inadequate response to the first-line MTX, from a Taiwan National Health Insurance Administration perspective. Materials and methods: A patient-level simulation model was used to project lifetime costs and quality-adjusted life-years (QALYs). Base-case analysis compared second-line treatment with tofacitinib 5 mg twice daily plus MTX vs adalimumab 40 mg every 2 weeks plus MTX. Patients switched or discontinued treatment due to a lack or loss of effectiveness or a serious adverse event. Efficacy was measured by change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score. HAQ-DI scores were used to predict mortality and resource utilization, and were mapped onto utility values to estimate QALYs. Efficacy and safety data were derived from clinical trials and other secondary sources. Uncertainty in model parameters was explored using one-way deterministic and probabilistic sensitivity analyses. Results: Patients gained 0.09 more QALYs with second-line tofacitinib plus MTX compared with adalimumab plus MTX (5.13 vs 5.04, respectively) at an additional cost of New Taiwan Dollars (NT$) 12,881. The incremental cost-effectiveness ratio was NT$143,122/QALY. One-way sensitivity analysis confirmed the base-case result was robust. Limitations: The lack of available clinical data, particularly for HAQ-DI scores, may introduce some bias in the analysis. No patients were in an early stage of RA, which may limit the generalizability of these results. Base-case results from our study are not necessarily generalizable to countries with healthcare systems that differ considerably from Taiwan. Conclusions: From a payer perspective, second-line treatment with tofacitinib plus MTX is a cost-effective treatment strategy, compared with adalimumab plus MTX, in patients with moderate-to-severe RA in Taiwan.

Original languageEnglish
Pages (from-to)777-787
Number of pages11
JournalJournal of Medical Economics
Volume22
Issue number8
DOIs
Publication statusPublished - Aug 3 2019

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Taiwan
Methotrexate
Cost-Benefit Analysis
Rheumatoid Arthritis
Quality-Adjusted Life Years
Therapeutics
Health
Patient Simulation
Janus Kinases
Costs and Cost Analysis
tofacitinib
Adalimumab
National Health Programs
Health Care Costs
Uncertainty
Clinical Trials
Delivery of Health Care
Safety
Mortality
Surveys and Questionnaires

Keywords

  • Cost-effectiveness
  • cost-utility
  • rheumatoid arthritis
  • Taiwan
  • tofacitinib

ASJC Scopus subject areas

  • Health Policy

Cite this

Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis : a cost-effectiveness analysis compared with adalimumab in Taiwan. / Chen, Der Yuan; Hsu, Ping Ning; Tang, Chao Hsiun; Claxton, Lindsay; Valluri, Satish; Gerber, Robert A.

In: Journal of Medical Economics, Vol. 22, No. 8, 03.08.2019, p. 777-787.

Research output: Contribution to journalArticle

Chen, Der Yuan ; Hsu, Ping Ning ; Tang, Chao Hsiun ; Claxton, Lindsay ; Valluri, Satish ; Gerber, Robert A. / Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis : a cost-effectiveness analysis compared with adalimumab in Taiwan. In: Journal of Medical Economics. 2019 ; Vol. 22, No. 8. pp. 777-787.
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N2 - Aims: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This analysis investigated the cost-effectiveness of the second-line treatment with tofacitinib, compared with adalimumab, both plus methotrexate (MTX), in patients with moderate-to-severe RA and an inadequate response to the first-line MTX, from a Taiwan National Health Insurance Administration perspective. Materials and methods: A patient-level simulation model was used to project lifetime costs and quality-adjusted life-years (QALYs). Base-case analysis compared second-line treatment with tofacitinib 5 mg twice daily plus MTX vs adalimumab 40 mg every 2 weeks plus MTX. Patients switched or discontinued treatment due to a lack or loss of effectiveness or a serious adverse event. Efficacy was measured by change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score. HAQ-DI scores were used to predict mortality and resource utilization, and were mapped onto utility values to estimate QALYs. Efficacy and safety data were derived from clinical trials and other secondary sources. Uncertainty in model parameters was explored using one-way deterministic and probabilistic sensitivity analyses. Results: Patients gained 0.09 more QALYs with second-line tofacitinib plus MTX compared with adalimumab plus MTX (5.13 vs 5.04, respectively) at an additional cost of New Taiwan Dollars (NT$) 12,881. The incremental cost-effectiveness ratio was NT$143,122/QALY. One-way sensitivity analysis confirmed the base-case result was robust. Limitations: The lack of available clinical data, particularly for HAQ-DI scores, may introduce some bias in the analysis. No patients were in an early stage of RA, which may limit the generalizability of these results. Base-case results from our study are not necessarily generalizable to countries with healthcare systems that differ considerably from Taiwan. Conclusions: From a payer perspective, second-line treatment with tofacitinib plus MTX is a cost-effective treatment strategy, compared with adalimumab plus MTX, in patients with moderate-to-severe RA in Taiwan.

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