OBJECTIVES : Rheumatoid arthritis (RA) is a chronic inflammatory disease. Although treatment target is the clinical remission (or at least low disease activity), only 23,5% of the patients achieve sustained remission. Upadacitinib is a newer JAK1 inhibitor with a proven efficacy and safety profile. This study aimed to perform a cost-minimization analysis considering upadacitinib for patients with moderate to severe RA with inadequate response or intolerance to previous conventional synthetic Disease-modifying anti-rheumatic drugs (csDMARD) treatments and estimate the budget impact for Brazil’s Unified Health System (SUS).

METHODS : A cost-minimization analysis was performed considering treatment costs on SUS perspective. Baricitinib is already available on SUS, has demonstrated similar efficacy to upadacitinib in terms of clinical remission (DAS28<2,6) and ACR response in two published metanalysis and therefore, was the comparator of choice. Budget impact analysis was performed considering all available treatments on SUS in a 5-years time horizon. with a scenario analysis for upadacitinib uptake assumptions. Induction, maintenance, administration, cold chain, and drug wastage costs were considered for both analyses.

RESULTS : Upadacitinib showed lower costs of treatment compared to baricitinib (BRL10,950.00 vs 11,070.45 in the first year) and the lowest cost comparing to all biologic DMARDs available in SUS with options up to 86% more expensive (infliximab: BRL20,377.84). Budget impact analysis demonstrated that the incorporation of upadacitinib would result in a saving of BRL6,26M in the first year and BRL117,97M in five years. Scenario analysis showed a saving of at least R$ 4M in five years.

CONCLUSIONS : Upadacitinib presented the lowest cost of treatment among available alternatives for the treatment of RA patients. Savings of almost BRL118M in 5 years are expected on SUS with upadacitinib incorporation, making Brazilian healthcare system more efficient.