Background

Targeted treatment of rheumatoid arthritis (RA) includes biological DMARDs (bDMARDs) and JAK inhibitors (JAKi). These agents are recommended at the same level on the basis of their efficacy and safety data. However, no local evidence of the impact of RA treatment regimens on total budget spending is available to date. This study aimed to explore the budget impact of different sequential targeted treatments in Thai patients with RA who failed at least three conventional synthetic DMARDs.

Methods

We used the adapted model to evaluate the budget impact of adding tofacitinib in different order to RA targeted treatment regimens. The Thai RA population eligible for treatment was assessed on the basis of local prevalence and experts’ opinion. Cost-impact analysis was evaluated for the treatment sequences of four different lines of targeted therapies using inputs like clinical efficacy, safety, and costs. The model used a decision tree structure with treatment nodes corresponding to treatment response outcomes for a cohort of patients. The comparisons included five bDMARDs [etanercept (ETN), infliximab (IFX), golimumab (GOL), rituximab (RTX), tocilizumab (TCZ) intravenous formulation], two JAKi [tofacitinib (TOF) and baricitinib (BAR)], and two IFX biosimilars (PF-06438179/GP1111 and CT-P13). A total of 80 treatment sequences within each containing four sequential first-, second-, third-, and fourth-line options were generated.

Results

The findings of the base case scenario indicated the treatment sequence with RTX as first-line, followed by IFX biosimilar (PF-06438179/GP1111), TOF, and TCZ, respectively, produced the lowest budget impact of US $693.54 million. Sensitivity analyses confirmed the robustness of our findings.

Conclusion

The order of targeted therapy starting with RTX, then IFX biosimilar, TOF, and finally TCZ incurred the lowest budget impact over a 5-year time horizon for treating moderate to severe RA. Our findings may help payers and policy makers consider appropriate budget allocation on chronic non-communicable diseases, especially RA.

中文翻译：

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泰国类风湿性关节炎患者使用生物制剂、生物仿制药和靶向合成疾病改善抗风湿药进行序贯治疗的预算影响

背景

类风湿性关节炎 (RA) 的靶向治疗包括生物 DMARDs (bDMARDs) 和 JAK 抑制剂 (JAKi)。根据其有效性和安全性数据，推荐使用相同水平的这些药物。然而，迄今为止，没有当地证据表明 RA 治疗方案对总预算支出的影响。本研究旨在探讨不同顺序靶向治疗对至少三种常规合成 DMARD 失败的泰国 RA 患者的预算影响。

方法

我们使用调整后的模型来评估以不同顺序将托法替尼添加到 RA 靶向治疗方案的预算影响。符合治疗条件的泰国 RA 人群根据当地患病率和专家意见进行评估。使用临床疗效、安全性和成本等输入，对四种不同靶向疗法的治疗序列进行成本影响分析。该模型使用决策树结构，其治疗节点对应于一组患者的治疗反应结果。比较包括五种 bDMARD [依那西普 (ETN)、英夫利昔单抗 (IFX)、戈利木单抗 (GOL)、利妥昔单抗 (RTX)、托珠单抗 (TCZ) 静脉制剂]、两种 JAKi [托法替尼 (TOF) 和巴瑞替尼 (BAR)]，以及两种IFX 生物仿制药（PF-06438179/GP1111 和 CT-P13）。

结果

基本案例情景的结果表明，治疗顺序以 RTX 作为一线，其次是 IFX 生物仿制药（PF-06438179/GP1111）、TOF 和 TCZ，分别产生了最低的预算影响，为 6.9354 亿美元。敏感性分析证实了我们发现的稳健性。

结论

从 RTX 开始，然后是 IFX 生物仿制药、TOF，最后是 TCZ 的靶向治疗顺序在 5 年时间范围内对治疗中度至重度 RA 的预算影响最低。我们的研究结果可能有助于付款人和政策制定者考虑为慢性非传染性疾病，尤其是 RA 分配适当的预算。