OBJECTIVES: To evaluate the cost-effectiveness of initiating treatment for psoriatic arthritis (PsA) with tofacitinib in comparison to interleukin IL-23/IL-12 and IL-17A antagonists, after failure or intolerance to a first line of anti-TNF biologic disease-modifying antirheumatic drugs (bDMARD population), from the Spanish National Health System perspective.

METHODS: A lifetime Markov model was developed. A panel of experts defined two sets of therapeutic sequences consisting on six lines of treatment, where only the first line was modified in order to compare tofacitinib versus ustekinumab, secukinumab and ixekizumab in bDMARD population. After six months of no response, patients switched to next treatment line. Response was evaluated using both 20% and 50% improvement in American College of Rheumatology criteria (ACR20 and ACR50, respectively) as the efficacy measures. Comparative efficacy data were inferred from a network meta-analysis and utilities were obtained from a post-hoc analysis of tofacitinib OPAL-BROADEN clinical trial. Direct medical resources and local unitary costs (€, 2018) were considered. Costs and outcomes were discounted at 3% and a 25.000€/quality-adjusted life-years (QALY) threshold value was used. Probabilistic sensitivity analysis were conducted.

RESULTS: Tofacitinib versus ustekinumab was associated with comparable QALYs gain (-0.04 and -0.006 for ACR20 and ACR50, respectively) with a cost reduction of 5,784.34€ and 3,140.65€. Similarly, secukinumab 300mg and ixekizumab generated a small QALYs gain while tofacitinib was associated in both cases with substantial incremental costs-savings (versus secukinumab: 18,104.33€ and 9,068.56€ for ACR20 & ACR50, respectively; versus ixekizumab: 6,622.14€ and 15,159.59€ for ACR20 & ACR50, respectively). Sensitivity analysis confirmed tofacitinib's probability of being cost-effective is over 90% for all comparisons.

CONCLUSIONS: Yielding similar QALYs gain, tofacitinib is the most cost-saving therapeutic option for PsA treatment after failure or intolerance to anti-TNF biologics in comparison to IL-23/IL-12 antagonist ustekinumab, or IL-17A antagonist secukinumab and ixekizumab, with a probability of being cost-effective over 90%.