OBJECTIVES:compare the budget impact of treating second line rheumatoid arthritis patients, with tofacitinib, an oral jak inhibitor which can be administered with or without MTX versus currently reimbursed biologic disease-modifying antirheumatic drugs (bDMARDs)+ MTXusing the Peruvian health system perspective

METHODS:We chose to perform a BIA comparing Tofacitinib with Adalimumab(ADA), Tocilizumab(TCZ), Etanercept(ETN) and Infliximab(INF). Treatment costs, which consisted of administration cost and drug costs(biologics + Methotrexate)[USD,2017] were calculated. Costs were obtained from Ministry of Health database(SEACE, 2017) and population and patient average weight was obtained from DEVAN database(DEVAN, 2017).The Peruvian health system perspective and a time horizon of one year were selected.Total population for analysis was based on disease prevalence of 0.5%(Vega-Hinojosa O. et al, 2017) and Furneri G. study(Furneri G. et al, 2012) on percentage of patients who do not present complete or good responses to conventional DMARDs and go on to treatment with biological DMARDs(bDMARDs)

RESULTS:The lowest estimated annual total cost of treatment per patient was associated with Tofacitinib($ 10,570) while the highest total cost of treatment was associated with TCZ($ 23,435)based on epidemiologic studies we assumed an hypothetic cohort of 3000 peruvian patients in second line RA. For these hypothetical cohort the lowest treatment costs were associated with Tofacitinib ($ 35,000,000) while the highest treatment cost was associated with TCZ ($ 70,306,000). It should be noted that, compared to the other available biologic drugs for RA, Tofacitinib will save the Peruvian government between $18,480,000 (vs. INF) and $35,000,000 (vs. TCZ) annually if all second line patients were treated with tofacitinib instead of current treatment options.

CONCLUSIONS:The Peruvian government could benefit from reimbursing Tofacitinib, by meeting efficacy criteria and having an economic advantage. There is also positive evidence on monotherapy treatment, thus avoiding the adverse effects of Methotrexate, which causes additional needs of resources to treat such events.