Incremental Cost per Remission in Patients With Rheumatoid Arthritis Who Had Inadequate Response to Conventional Synthetic Disease-Modifying Antirheumatic Drugs in Colombia

OBJECTIVES: Attaining remission in patients with rheumatoid arthritis (RA) has shown to yield improvement in symptoms and quality-of-life. Evidence regarding the incremental cost of remission among JAKi therapies is limited in Latin America. The objective was to estimate the incremental cost per remission (ICPR) for JAK inhibitors relative to csDMARD in patients with RA who were csDMARD-IR from a payer perspective in Colombia.

METHODS: A model was developed to calculate the incremental cost per patient in remission (ICPR) at 12 and 24 weeks. Efficacy inputs were obtained from a network meta-analysis. Drug costs were obtained from the official drug price database (SISMED) and direct medical costs based on level of disease activity were estimated by clinical experts and included clinical exams, drug use, physician consultation, hospitalization, and emergency visits.

RESULTS: Average total cost per patient ranged from COP$1,593,245 (€351.74) with csDMARD to COP$7,840,025 (€1,730.83) with UPA-15mg+csDMARD and from COP$3,120,257 (€688.85) to COP15,565,054 (€3,436.27) at week 12 and week 24 respectively. ICPR ranged from COP$1,832,459 (€404.55) with UPA15mg+csDMARD to COP$10,015,013 (€2,211.00) with BAR-2mg+csDMARD per additional patient in remission at week 12. The results were consistent at week 24, with UPA-15mg+csDMARD showing the lowest cost per additional patient in remission vs all other JAKi, with a ICPR of COP$10,889,817(€2,404.12) in comparison to COP$21,671,269 (€4,784.32), COP$15,386,269 (€3,396.80) and COP$43,232,850 (€9,544.43) for BAR-2mg+csDMARD, BAR-4mg+csDMARD, and TOF-5mg+csDMARD, respectively. Considering a fixed healthcare budget of COP$1,000,000,000 (€220,768.10), UPA-15mg+csDMARD would help 545 additional patients achieve remission, in contrast with 99, 160 and 443 patients with BAR-2mg+csDMARD, BAR4mg+csDMARD and TOF-5mg+csDMARD, respectively.

CONCLUSIONS: From a payer perspective, upadacitinib showed the lowest incremental-cost-per-additional patient in remission of RA among available JAK-inhibitor based-therapies in Colombia. Therefore, more patients in remission could be achieved with upadacitinib for a fixed healthcare budget.