Cost-effectiveness analysis of tofacitinib compared with adalimumab and etanercept in the treatment of severe active rheumatoid arthritis; Iranian experience

Fatemi, Behzad; Rezaei, Soheila; Taheri, Saeed; Peiravian, Farzad

doi:10.1080/14737167.2021.1834384

Cited by 6 publications

(16 citation statements)

References 42 publications

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“…We included seventeen ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Fournier et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Van De Laar et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Fatemi et al, 2021 ; Ha et al, 2021 ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) relevant studies for systematic review, of which fifteen studies ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Van De Laar et al, 2020 ; Li et al, 2021a ; Fatemi et al, 2021 ; Ha et al, 2021 ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) were eligible for meta-analysis ( Figure 1 ). All the studies with JAK-i as an intervention were included for the meta-analysis ( n = 15), whereas studies that compared JAK-i versus JAK-i ( n = 2) were included for systematic review only ( Fournier et al, 2019 ; Li et al, 2021b ).…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies ( Lee et al, 2015 ; Claxton et al, 2018 ; Chen et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Van De Laar et al, 2020 ; Li et al, 2021a ; Fatemi et al, 2021 ; Ha et al, 2021 ; Tan et al, 2021 ; Kuwana et al, 2022 ) assessed the cost-effectiveness of JAK-i as second line treatment in RA patients who showed an inadequate response to csDMARDs. Five studies ( Jansen et al, 2017 ; Claxton et al, 2018 ; Navarro et al, 2020 ; Tan et al, 2021 ; Tan et al, 2022 ) assessed the cost-effectiveness of JAK-i compared to csDMARD/bDMARDs as the third-line treatment for RA patients who showed an inadequate response to TNF-a-i following csDMARD failure.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Fournier et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Van De Laar et al, 2020 ; Ha et al, 2021 ; Kuwana et al, 2022 ) were from High-income countries (HIC), five studies from upper-middle-income countries (UMICs) ( Tian et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Tan et al, 2021 ; Tan et al, 2022 ) and only one study from lower middle-income country (LMICs). ( Fatemi et al, 2021 ) ICER was calculated from a Health system perspective in eleven studies, ( Claxton et al, 2018 ; Fournier et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) societal perspective in four studies, ( Lee et al, 2015 ; Jansen et al, 2017 ; Van De Laar et al, 2020 ; Ha et al, 2021 ) and payer’s perspective in two studies. ( Chen et al, 2019 ; Fatemi et al, 2021 ) All studies used a model-based analytical approach, out of which eleven studies ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) used an event simulation model, and six studies ( Fournier et al, 2019 ; Muszbek et al, 2019 ; Tian et al, 2020 ; Van De Laar et al, 2020 ; Fatemi et al, 2021 ; Ha et al, 2021 ...…”

Section: Resultsmentioning

confidence: 99%

“…(Chen et al, 2019;Fatemi et al, 2021) All studies used a model-based analytical approach, out of which eleven studies (Lee et al, 2015;Jansen et al, 2017;Claxton et al, 2018;Chen et al, 2019;Schlueter et al, 2019;Navarro et al, 2020;Li et al, 2021a;Li et al, 2021b;Tan et al, 2021;Kuwana et al, 2022;Tan et al, 2022) used an event simulation model, and six studies (Fournier et al, 2019;Muszbek et al, 2019;Tian et al, 2020;Van De Laar et al, 2020;Fatemi et al, 2021;Ha et al, 2021) 2020) (five-year horizon) used a lifetime horizon for the calculation of costs and QALY (n = 15). (Lee et al, 2015;Jansen et al, 2017;Claxton et al, 2018;Chen et al, 2019;Muszbek et al, 2019;Schlueter et al, 2019;Navarro et al, 2020;Tian et al, 2020;Li et al, 2021a;Li et al, 2021b;Fatemi et al, 2021;Ha et al, 2021;Tan et al, 2021;Kuwana et al, 2022;Tan et al, 2022).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Cost-effectiveness of janus kinase inhibitors for rheumatoid arthritis: A systematic review and meta-analysis of cost-utility studies

et al. 2022

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Introduction: Janus kinase inhibitors (JAK-i), a class of targeted synthetic disease-modifying antirheumatic drugs (tDMARDs), are suggested as second or third-line therapies in rheumatoid arthritis (RA). Synthesized cost-effective evidence would aid in informed decision-making given the similar clinical effectiveness of JAKi, but incongruent cost-effectiveness reports.Methods: Literature search was conducted in PubMed, Embase, Scopus, and Tufts Medical Centers’ cost-effective analysis registry. We pooled the incremental net benefit (INB) with 95% confidence interval (CI) using random-effects model and the heterogeneity was assessed using Cochrane-Q test and I2 statistic. Modified economic evaluation bias checklist was used to assess the quality of selected studies. Publication bias was assessed using a funnel plot and Egger’s test. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) assessment was performed to assess the certainty of outcomes presented.Results: We included seventeen relevant studies for systematic review, of which fifteen were eligible for meta-analysis. The meta-analysis results showed that JAK-i is cost-effective compared to csDMARDS/bDMARDs with a pooled INB (INBp) of $19,886 (95% CI, 1,635 to 38,137) but with considerable heterogeneity (I2 = 99.14). As a second-line treatment for csDMARD failed RA, JAK-i is cost-effective than csDMARD/bDMARD with a pooled INB of $23,144 (74.1–46,214) and high heterogeneity (I2 = 99.67). But on a separate analysis JAK-i as second-line treatment is not cost-effective than TNF-a-i (INBp = $25,813, -5,714 to 57,340). However, leave-one-out analysis found that omitting a single outlier makes JAK-i cost-effective. Further, JAK-i is not cost-effective as a third-line treatment for csDMARD-TNF-a-I failed RA, compared to csDMARDs/bDMARDs with INBp $26,157 (-7,284 to 59,598).Conclusion: Meta-analysis suggests that JAK-i is cost-effective when used after csDMARD failure but not cost-effective when used after csDMARD-TNF-a-i failure with low certainty of evidence.Clinical Trial Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222541, identifier CRD42021222541

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Cost-effectiveness of janus kinase inhibitors for rheumatoid arthritis: A systematic review and meta-analysis of cost-utility studies

et al. 2022

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“…Tofacitinib also cost less than Adalimumab ($ 50,299.91 vs. $ 51,550.29) and had more QALYs (6,900 vs. 6,687). The sensitivity analysis also showed that the results were sensitive to the cost of the medications [ 50 ]. These findings are in line with those of the present study.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Biopharmaceuticals for Treating Rheumatoid Arthritis: Infliximab, Adalimumab, and Etanercept

Gholami

Azizpoor

Aflaki

et al. 2021

BioMed Research International

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Introduction. Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease that causes joint destruction. The condition imposes a significant economic burden on patients and societies. The present study is aimed at evaluating the cost-effectiveness of Infliximab, Adalimumab, and Etanercept in treating rheumatoid arthritis in Iran. Methods. This is a cost-effectiveness study of economic evaluation in which the Markov model was used. The study was carried out on 154 patients with rheumatoid arthritis in Fars province taking Infliximab, Adalimumab, and Etanercept. The patients were selected through sampling. In this study, the cost data were collected from a community perspective, and the outcomes were the mean reductions in DAS-28 and QALY. The cost data collection form and the EQ-5D questionnaire were also used to collect the required data. The results were presented in the form of an incremental cost-effectiveness ratio, and the sensitivity analysis was used to measure the robustness of the study results. The TreeAge Pro and Excel softwares were used to analyze the collected data. Results. The results showed that the mean costs and the QALY rates in the Infliximab, Adalimumab, and Etanercept arms were $ 79,518.33 and 12.34, $ 91,695.59 and 13.25, and $ 87,440.92 and 11.79, respectively. The one-way sensitivity analysis confirmed the robustness of the results. In addition, the results of the probabilistic sensitivity analysis (PSA) indicated that on the cost-effectiveness acceptability curve, Infliximab was in the acceptance area and below the threshold in 77% of simulations. The scatter plot was in the mentioned area in 81% and 91% of simulations compared with Adalimumab and Etanercept, respectively, implying lower costs and higher effectiveness than the other two alternatives. Therefore, the strategy was more cost-effective. Conclusion. According to the results of this study, Infliximab was more cost-effective than the other two medications. Therefore, it is recommended that physicians use this medication as the priority in treating rheumatoid arthritis. It is also suggested that health policymakers consider the present study results in preparing treatment guidelines for RA.

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Adalimumab exhibits superiority over etanercept in terms of a numerically higher response rate and equivalent adverse events: A real‐world finding

Yu,

Gao,

Zang

et al. 2024

Immunity Inflam & Disease

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IntroductionAdalimumab (ADA) and etanercept (ETN) are the most commonly applied biologics for rheumatoid arthritis (RA) management in China; however, the evidence regarding their superiority is controversial. In addition, in real‐world clinical settings, many factors may affect the application of these agents, such as dosage and administration period. Therefore, the present real‐world study aimed to compare the efficacy and safety of ADA and ETN treatment in RA patients via the propensity score matching method.MethodsIn total, 105 RA patients receiving ADA (n = 66) or ETN (n = 39) were reviewed in this retrospective study. The propensity score matching method was used to eliminate discrepancies in baseline features. Clinical response, low disease activity (LDA), and remission were evaluated based on the DAS28.ResultsBefore propensity score matching, compared with ETN, ADA yielded higher rates of clinical response at W24 (97.0% vs. 84.6%, p = .021), LDA at W12 (78.8% vs. 51.3%, p = .003), and remission at W24 (75.8% vs. 46.2%, p = .002). After propensity score matching, compared with ETN, ADA only achieved a higher rate of clinical response at W24 (96.3% vs. 77.8%, p = .043), whereas the rates of LDA and remission were not different between ADA and ETN treatments at any time point (all p > .05). In addition, the incidence of adverse events was not significantly different between the ADA and ETN treatments (all p > .05).ConclusionADA shows superiority over ETN in terms of a numerically greater response rate and equivalent adverse events.

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Cost-effectiveness analysis of tofacitinib compared with adalimumab and etanercept in the treatment of severe active rheumatoid arthritis; Iranian experience

Cited by 6 publications

References 42 publications

Cost-effectiveness of janus kinase inhibitors for rheumatoid arthritis: A systematic review and meta-analysis of cost-utility studies

Cost-effectiveness of janus kinase inhibitors for rheumatoid arthritis: A systematic review and meta-analysis of cost-utility studies

Cost-Effectiveness Analysis of Biopharmaceuticals for Treating Rheumatoid Arthritis: Infliximab, Adalimumab, and Etanercept

Adalimumab exhibits superiority over etanercept in terms of a numerically higher response rate and equivalent adverse events: A real‐world finding

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