OBJECTIVES: The purpose of this study was to determine the cost-effectiveness of upadacitinib (an oral, reversible JAK inhibitor) versus methotrexate (cDMARDs) as a first-line monotherapy in the treatment of rheumatoid arthritis (RA) in the US.

METHODS: A decision analysis model was constructed with a time horizon of 3 months and a US payer’s perspective was assumed. The effectiveness measure was based on probability of achieving a score of less than or equal to 3.2 on the 28 joint Disease Activity Score (DAS28). The effectiveness data was derived from published clinical trial information. Costs of the drugs were based on average wholesale price and were obtained from Redbook 2019. Cost of hospitalization, outpatient cost and treatment cost for adverse events were considered and were obtained from published literature. All costs were adjusted to 2019 US Dollars using the medical care component of the Consumer Price Index from the Bureau of Labor Statistics. TreeAge Pro 2019 was used to construct the model. A series of one-way sensitivity analyses were performed to assess the robustness of the model results.

RESULTS: Treatment of RA with upadacitinib ($19,826) is more expensive than that with the methotrexate ($662) for a given time horizon of 3 months. The percentage for achieving a score of <= 3.2 on DAS 28 was 73% for upadacitinib and 27% for methotrexate. The incremental cost-effectiveness ratio of Drug A vs. Drug B was $ 225,687.13 per additional patient achieving a score of <= 3.2 on DAS28 over the period of 3 months. One-way sensitivity analysis findings showed the robustness of the results.

CONCLUSIONS: The results suggest that upadacitinib appears to be cost-effective compared to methotrexate for achieving a score of <= 3.2 on DAS28. These findings were robust for plausible ranges of effectiveness and drug acquisition costs.