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Tofacitinib in the Treatment of Moderate-to-Severe Rheumatoid Arthritis in China: A Cost-Effectiveness Analysis Based on a Mapping Algorithm Derived from a Chinese Population

Abstract

Introduction

To estimate the cost-effectiveness of tofacitinib for patients with moderate-to-severe rheumatoid arthritis (RA) who failed conventional synthetic disease-modifying antirheumatic drugs from the Chinese healthcare system perspective.

Methods

An individual patient simulation model was used to estimate the lifetime cost and effectiveness. The comparator sequence commenced with etanercept, followed by rituximab-tocilizumab- non-biologic therapy. The intervention sequences were assumed to add tofacitinib to different positions in the comparator sequence. Quality-of-life estimates were generated by mapping Health Assessment Questionnaire scores to utility with the algorithm derived from a Chinese population. Scenario analyses, univariable and probabilistic sensitivity analyses were performed to evaluate the model uncertainty.

Results

Compared with the comparator sequence, patients receiving tofacitinib as the first-, second-, third- and fourth-line treatment gained additional 0.49, 0.59, 0.44 and 0.53 QALYs, respectively, and the use of tofacitinib as the first- and second-line treatment was less costly, whereas the use of tofacitinib as the third- and fourth-line treatment cost an additional $234,998 and $381,116, respectively. This produced an incremental cost-effectiveness ratio of $333.73 and $9669.34/QALY, respectively.

Conclusion

Tofacitinib is estimated to be dominant in both the first- and second-line settings and to be highly cost-effective in both the third- and fourth-line settings.

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Acknowledgements

Funding

This study and the journal’s Rapid Service Fee were supported by the National Natural Science Foundation of China (no. 71874209) and Hunan Provincial Natural Science Foundation of China (no. 2019JJ40411).

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Authors’ Contributions

Wan XiaoMin and Chongqing Tan, Sini Li, Lidan Yi and Xiaohui Zeng developed the economic model, performed the analyses, interpreted the results and drafted the article. Liubao Peng, Shuxia Qin and Liting Wang collected and reviewed the data. XiaoMin Wan contributed to the conception and design of the primary model. All authors read and approved the final article.

Disclosures

Chongqing Tan, Sini Li, Lidan Yi, Xiaohui Zeng, Liubao Peng, Shuxia Qin, Liting Wang and Xiaomin Wan declare they have nothing to disclose.

Compliance with Ethics Guidelines

The model used in this analysis was based on previously conducted studies and other economic models; no studies with human participants or animals were performed by any of the authors. Ethics committee approval is not required.

Data Availability

All data generated or analyzed during this study are included in this published article/as supplementary information files.

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Corresponding author

Correspondence to Xiaomin Wan.

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Tan, C., Li, S., Yi, L. et al. Tofacitinib in the Treatment of Moderate-to-Severe Rheumatoid Arthritis in China: A Cost-Effectiveness Analysis Based on a Mapping Algorithm Derived from a Chinese Population. Adv Ther 38, 2571–2585 (2021). https://doi.org/10.1007/s12325-021-01733-7

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  • DOI: https://doi.org/10.1007/s12325-021-01733-7

Keywords

  • Cost-effectiveness
  • Etanercept
  • Model
  • Rheumatoid arthritis
  • Tofacitinib