Introduction A phase 3 (RA-BEAM study) clinical trial reported that baricitinib (BCT) + methotrexate (MTX) had clinical improvement compared with adalimumab (ADA) + MTX as a first-line strategy in patients with rheumatoid arthritis (RA) who had inadequate responses to MTX monotherapy. However, from the perspective of the Chinese healthcare system, the cost-effectiveness of introducing BCT into current treatment for patients with RA unresponsive to MTX remains unclear. Methods A patient-level microsimulation model was used to extrapolate the lifetime incremental cost per quality-adjusted life-year (QALY) and other outcomes. This study compared treatment sequences with or without first-line BCT with current treatment sequences, including adalimumab, etanercept, tocilizumab, and palliative care. Effectiveness and physical function were assessed using the American College of Rheumatology (ACR) 20/50/70 response and Health Assessment Questionnaire (HAQ). The input parameters of the model, comprising patient characteristics (sex and age) and treatment efficacy (ACR responses and HAQ score), were derived from a phase III clinical trial and network meta-analysis. The total cost estimation included direct costs and indirect costs. Probabilistic and univariate sensitivity analyses were performed, as were a series of scenario analyses. Results The lifetime analysis revealed that adding BCT as a first-line treatment resulted in a QALY gain of 2.66 years; this gain would cost an incremental $26,662, leading to an incremental cost-effectiveness ratio of $10,036/QALY per patient compared with the current treatment sequence. Sensitivity and scenario analyses showed the results to be robust. Conclusions From a Chinese payer perspective, the introduction of BCT into the current treatment sequence is projected to be a cost-effective option as first-, second-, third-, and fourth-line treatment for patients with moderate-to-severe RA. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00308-w.

Background: Recent randomized controlled trials have demonstrated that immune checkpoint inhibitors (ICIs) improve patient outcomes, but whether these novel agents are cost-effective for untreated advanced renal cell carcinoma (aRCC) remains unclear.Materials and Methods: A microsimulation model was created to project the healthcare costs and outcomes of six strategies (lenvatinib-plus-pembrolizumab, nivolumab-plus-cabozantinib, nivolumab-plus-ipilimumab, pembrolizumab-plus-axitinib, avelumab-plus-axitinib, and sunitinib monotherapy) for patients with aRCC. Transition probability of patients was estimated from CLEAR, CheckMate 9ER, CheckMate 214, KEYNOTE-426, JAVELIN Renal 101, and other data sets by using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated from a United States payer perspective. One-way and probabilistic sensitivity analyses were performed, along with multiple scenario analyses, to evaluate model uncertainty.Results: Of the six competing strategies, nivolumab-plus-cabozantinib yielded the most significant health outcomes, and the sunitinib strategy was the least expensive option. The cost-effective frontier consisted of the nivolumab-plus-cabozantinib, pembrolizumab-plus-axitinib, and sunitinib strategies, which displayed the ordered ICERs of $81282/QALY for pembrolizumab-plus-axitinib vs sunitinib and $453391/QALY for nivolumab-plus-cabozantinib vs pembrolizumab-plus-axitinib. The rest of the strategies, such as lenvatinib-plus-pembrolizumab, nivolumab-plus-ipilimumab, and avelumab-plus-axitinib, were dominated. The cost of sunitinib drove the model most influentially.Conclusions: For aRCC, the pembrolizumab-plus-axitinib strategy is likely to be the most cost-effective alternative at the willingness-to-pay threshold of $100,000.