OBJECTIVES: To compare the budget impact analysis(BIA) for rheumatoid arthritis patients treated with tofacitinib, an oral jak inhibitor versus currently available biologic disease-modifying antirheumatic drugs (bDMARDs).under the Peruvian health system perspective

METHODS: We chose to perform a BIA comparing Tofacitinib against Adalimumab (ADA),Tocilizumab (TCZ),Etanercept (ETN),Abatacept (ABA)and Golilumab(GOL).Treatment costs consisted in administration and the drug itself (biologics + Methotrexate) [USD,2017–exchange rate 3.3] were calculated.Costs were obtained from Ministry of Health database (SEACE –ESSALUD - MINSA, 2017) and population and patient average weight were obtained from DEVAN database (DEVAN, 2017).The Peruvian health system perspective and a time horizon of one year were selected. The total population for analysis was based on disease prevalence of 0.5% in Peru (Vega-Hinojosa O. et al,2017) and Furneri G. study (Furneri G. et al,2012) on percentage of patients who did not have complete or good response to conventional DMARDs; and move on to biological DMARDs (bDMARDs).

RESULTS: The lowest estimated annual total cost of treatment per patient was associated with Tofacitinib ($ 11,709) while the highest total cost of treatment was associated with ABA ($22,566) followed by TCZ ($ 18,750). Based on epidemiological studies we assumed an hypothetic cohort of 3000 peruvian patients with RA on second line treatment.For these hypothetical cohort the lowest treatment costs was associated with Tofacitinib ($ 35,127,000) while the highest was associated with ABA ($ 67,698,000)TCZ ($ 56,250,000).It should be noted that, compared to available biologic drugs for RA, Tofacitinib would have save the Peruvian government between $2,559,000 (vs. ETN) and $32,571,000 (vs. ABA) annually if all patients were treated with tofacitinib instead of current treatment options.

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