OBJECTIVES: The aim of this study was to determine the value contribution of filgotinib for the treatment of moderate to severe rheumatoid arthritis in Spain, compared with two therapeutic alternatives.

METHODS: EVIDEM Multi-Criteria Decision Analysis (MCDA) framework was selected. A literature review was conducted to populate the framework, comprised of 12 quantitative and 4 contextual criteria. A multidisciplinary panel of 9 experts determined the value contribution of filgotinib with respect to upadacitinib and baricitinib. Mean and standard deviation were calculated for quantitative criteria while qualitative criteria were analysed as percentages of experts that considered a positive, neutral or negative impact for the Spanish National Health System. Global value contribution of filgotinib was calculated.

RESULTS: Moderate to severe rheumatoid arthritis was considered a severe disease (mean±SD: 3.4±0.9), with moderate size of affected population (3.0±0.7) and moderate unmet needs (2.9±0.8). Experts perceived that filgotinib might provide a marginal benefit in efficacy/effectiveness (1.5±1.3) and safety/tolerability (1.4±1.1), whereas minimal differences were found in patient-reported outcomes (PROs) (0.5±1.1). Therapeutic benefit provided by filgotinib was considered moderate to high (3.6±0.7). Experts anticipated an average or lower cost of treatment (1.7±1.1) and no impact on other medical costs (0.1±0.3) and non-medical/indirect costs (0.1±0.3) was expected. Evidence presented for filgotinib was considered robust (4.6±0.7), with high consensus among experts on its future recommendation in Spanish guidelines (2.4±1.1). In contextual criteria, most experts perceived a positive impact on population priorities and access (89%), common goal and specific interests (67%) and system capacity and appropriate use (78%). Impact on opportunity costs and affordability was considered neutral (56%). The result of the global value contribution of filgotinib was 0.44 (in a -1 to +1 scale).

CONCLUSIONS: Filgotinib provides an added value to moderate to severe rheumatoid arthritis management, showing a good risk/benefit balance and constituting a valuable therapeutic alternative in Spain.