OBJECTIVES:

To determine the cost effectiveness of adalimumab biosimilars, an anti TNF biologic and current licensed Janus kinase (JAK) inhibitors for the treatment of moderate-to-severe Rheumatoid Arthritis (RA).

METHOD

A treatment sequence age-dependent Markov model was developed to compare the cost effectiveness of adalimumab biosimilars versus JAK inhibitors (upadacitinib, filgotinib, tofacitinib and baricitinib). Model outcomes were based on 10,000 simulations with ACR20, ACR50 and ACR70 probabilities determined from SELECT COMPARE, FINCH 1, ORAL STANDARD, RA-BEAM and RA-BUILD studies. Patients not achieving ACR20 at week 24 were deemed to have had an inadequate response to treatment and the patient assessed to move to supportive care for the lifetime model time horizon. Unit costs were taken from publicly available databases with adalimumab biosimilar discounting based on current market dynamics.

RESULTS:

Incremental QALY’s per patient were calculated to be 0.14 (tofacitinib), 0.09 (baricitinib), 0.07 (filgotinib) and 0.04 (upadacitinb). Examples of incremental costs per patient within the JAK arms at list price and with a 30% discount were determined to be for the UK: £13,603/£8,166 (Tofacitinib), £32,848/£21,634 (baricitinib), £31,901/£20,970 (filgotinib) and £27,495/£17,883 (upadacitinb). For Spain, the incremental cost per patient was €10,947/€5,423 (Tofacitinib), €29,715/€18,561 (baricitinib) and €24,404/€14,843 (Upadacitinib). In all scenario’s, the Incremental Cost-Effectiveness Ratio’s (ICER’s) for adalimumab were dominant.

CONCLUSIONS:

Adalimumab biosimilars continue to be a cost-effective option in the treatment of moderate-to severe RA. The uptake and use of adalimumab biosimilars continue to increase the affordability and therefore possible access to treatments for patients suffering from this chronic long-term condition.