OBJECTIVES:To compare cost of treating rheumatoid arthritis patients that have failed an initial treatment with methotrexate(MTX), with Tofacitinib, an oral jak inhibitor which can be administered with or without MTX versus other biologic disease-modifying antirheumatic drugs(bDMARDs)+MTXusing the Ecuadorian health system perspective

METHODS:We chose to perform a cost minimization analysis comparing Tofacitinib with Adalimumab(ADA),Tocilizumab(TCZ),Etanercept(ETN),Infliximab(INF),Golimumab(GOL) and Rituximab(RIT) since it has been proven that efficacy and safety results in combination with MTX are similar between these bDMARDs(Bergrath E.et al,2017).The cost of treatment, which included cost of diagnosis, costs of disease control, drug administration costs, and drug costs(bDMARDs+MTX), was analyzed over one year time frame(USD,2017). Pharmaceutical and administration costs(USD2017) of all available bDMARDs drugs were considered.Administration costs were obtained from Health National Tariff(MSP,2014).To test the robustness of the study, a deterministic and probabilistic sensitivity analyzes were performed.In the deterministic sensitivity analysis changes were made in the remission of disease(5-53%).For probabilistic sensitivity analysis, a Gamma distribution was performed for the different administration costs($10 SD).The Monte Carlo methodology was used, for which 1,000 simulations were carried out

RESULTS:The lowest estimated annual total cost of treatment was associated with Tofacitinib($9,876) while the highest total cost of treatment was associated with Adalilumab($14,866).It should be noted that compared with the two bDMARDs currently included in Ecuador NFL since 2014(ETN and INF),Tofacitinib results annually and per patient were 40% less expensive than INF and 25% less expensive than ETN.The deterministic and probabilistic sensitivity analyzes results were robust in reporting tofacitinib as the lowest cost model.

CONCLUSIONS:The Ecuadorian government could benefit from reimbursing Tofacitinib as a treatment option for RA having an economic advantage over those two options that are currently reimbursed.Over and above the lower budget impact, tofacitinib also has positive evidence in monotherapy thus avoiding the adverse effects of MTX,which causes additional needs of resources to treat such events