OBJECTIVES

: This study assessed the cost-effectiveness of introducing tofacitinib to the standard treatment sequence for Chinese patients with moderate-to-severe rheumatoid arthritis (RA) with inadequate response to conventional disease-modifying antirheumatic drugs (cDMARDs-IR).

METHODS

: Following Chinese rheumatology guidelines for treating RA patients with cDMARDs-IR, a Markov model was constructed from the perspective of the Chinese healthcare system to simulate the lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER) comparing treatment sequences with/without tofacitinib as 1^st line treatment. The current treatment sequence included etanercept, adalimumab, infliximab and tocilizumab. Direct costs were derived from publicly available sources of 2018; health-related quality of life of patients was estimated using Health Assessment Questionnaire-Disability Index (HAQ-DI)-to-EuroQoL 5D (EQ-5D) mapping. Clinical trials and real-world data were utilized for mapping generating transition probabilities and incidence of adverse events. Mortality probabilities were estimated from the RA based Chinese all-cause mortality data. One-way and probabilistic sensitivity analyses were conducted for verifying the robustness of the model. In addition, tofacitinib was evaluated as 2^nd line and 3^rd line treatment options in scenario analyses to further determine its cost-effectiveness.

RESULTS

: Compared to current treatment sequence, adding tofacitinib as the 1st line treatment led to incremental costs of $7,030 and incremental QALYs of 2.21, resulting in an ICER of $3,181/QALY. One-way and probabilistic sensitivity analyses showed the results to be robust. The ICERs of inserting tofacitinib as 2^nd and 3^rd line treatment into standard treatment sequence were $4,759/QALY and $15,483/QALY, respectively.

CONCLUSIONS

: Using the WHO recommended ICER acceptability threshold of ≤3 times of the per capita GDP, the inclusion of tofacitinib to the current treatment sequence for moderate-to-severe RA patients with cDMARDs-IR in China is a cost-effective option as 1^st, 2^nd, and 3^rd line treatment. Introducing tofacitinib as the 1^st line treatment post cDMARD-IR resulted in the most cost-effective intervention.