OBJECTIVES: To compare the cost of treating rheumatoid arthritis patients that have failed treatment with TNFi, 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 Abatacept(ABA), Tocilizumab(TCZ) 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 (USD 2017) 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 Standard deviation). 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 Abatacept ($ 33,025). 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 third line RA having an economic advantage over currently available third line RA drugs in the market. Over and above the lower budget impact, tofacitinib also has positive evidence in monotherapy treatment thus avoiding the adverse effects of MTX, which causes additional needs of resources to treat such events.