ABSTRACT

Background and objective

This study aimed to evaluate the cost-utility of Tofacitinib (TFC) in patients with severe rheumatoid arthritis (RA) who had not responded well to methotrexate from the Iranian payer’s perspective.

Methods

An individual microsimulation Markov model was developed to compare TFC with etanercept (ETN) and Adalimumab (ADA) over a life-time horizon. Treatment efficacy was estimated based on the American College of Rheumatology (ACR) response improvement criteria in 6 months. Changes in the Health Assessment Questionnaire (HAQ) scores were mapped onto utility values to calculate outcomes in terms of QALYs. Direct medical costs were taken from national databases. Uncertainty in model parameters was evaluated by sensitivity analyses.

Results

This study demonstrated that TFC was cost-effective in both scenarios. Although TFC was associated with lower QALYs than ETN (6.664 versus 6.876), it was also associated with lower costs over a life-time horizon ($42,565.04 versus $58,696.29). Additionally, TFC was found to be the dominant strategy with a lower cost ($50,299.91 versus $51,550.29) and higher QALYs gained (6.900 versus 6.687) compared to ADA.

Conclusion

TFC was found to be cost-effective in patients with severe RA who do not respond well to methotrexate compared to ADA, ETN in Iran.

中文翻译：

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托法替尼与阿达木单抗和依那西普治疗严重活动性类风湿关节炎的成本效益分析；伊朗的经历

摘要

背景和目标

本研究旨在从伊朗付款人的角度评估托法替尼 (TFC) 在对甲氨蝶呤反应不佳的严重类风湿性关节炎 (RA) 患者中的成本效用。

方法

开发了一个个体微观模拟马尔可夫模型，以在整个生命周期内比较 TFC 与依那西普 (ETN) 和阿达木单抗 (ADA)。根据美国风湿病学会 (ACR) 在 6 个月内的反应改善标准估计治疗效果。将健康评估问卷 (HAQ) 分数的变化映射到效用值，以根据 QALY 计算结果。直接医疗费用取自国家数据库。通过敏感性分析评估模型参数的不确定性。

结果

这项研究表明，TFC 在这两种情况下都具有成本效益。尽管 TFC 与低于 ETN 的 QALY 相关（6.664 对 6.876），但它也与整个生命周期内的成本降低相关（42,565.04 美元对 58,696.29 美元）。此外，与 ADA 相比，发现 TFC 是成本更低（50,299.91 美元对 51,550.29 美元）和获得更高 QALY（6.900 对 6.687）的主导策略。

结论

与伊朗的 ADA、ETN 相比，TFC 被发现对甲氨蝶呤反应不佳的严重 RA 患者具有成本效益。