OBJECTIVES : Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation and leads to bone destruction and other extra-articular and systemic manifestations. This analysis examined the cost-effectiveness of tofacitinib in patients with RA in China.

METHODS : A previously published lifetime, cohort-based, cost-effectiveness model for patients with rheumatoid arthritis was localized to China. The model evaluated three possible lines of biologic disease-modifying antirheumatic drugs (bDMARDs) therapy plus a final line of palliative care in patients with an inadequate response to non-biologic DMARDs (cDMARD-IR). Included therapeutic options were the following: tofacitinib, YSP (etanercept biosimilar), adalimumab, infliximab, toclizumab, and palliative care (methotrexate and leflunomide). YSP was assumed to have equal effectiveness to etanercept in the base case, and 90% in sensitivity analysis. Response to therapy was evaluated every 6 months through American College of Rheumatology (ACR) criteria (first-line biologic) and Health Assessment Questionnaire Disability Index (HAQ-DI) scores (subsequent lines). HAQ-DI scores were mapped to utility values to calculate QALYs. Drug costs, adverse events (injection-site reactions and severe infections), physician costs, and administration costs were included. Costs were presented in 2017 CNY and from a payer’s perspective.

RESULTS : The sequence of tofacitinib, adalimumab, and infliximab dominated (less costly, more effective than) YSP followed by adalimumab, and then toclizumab (incremental costs and QALYs of -¥39,257 and 0.44). Tofacitinib was cost-effective against YSP when both treatments were followed by infliximab (second-line) and toclizumab (third-line) with an ICER of ¥380 (incremental cost and QALYs of ¥172 and 0.45, respectively). Tofacitinib was, again, cost-effective against YSP when both were followed by adalimumab (second-line) and toclizumab (third-line) with an ICER of ¥86,688 (incremental costs and QALYs of ¥58,589 and 0.68, respectively). Sensitivity analysis related to YSP’s effectiveness confirmed the base case results.

CONCLUSIONS : Tofacitinib is a cost-effective alternative to YSP in patients with rheumatoid arthritis in China.