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Budget Impact of Sequential Treatment with Biologics, Biosimilars, and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Thai Patients with Rheumatoid Arthritis

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Abstract

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.

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Acknowledgements

The authors would like to acknowledge Ms. Vaidehi Wadhwa (Senior Scientific Communications Specialist, Medical Excellence, Emerging Markets, Pfizer) for her medical writing and editorial support for developing this manuscript.

Funding

The study process and the Rapid Service Fee were funded by Pfizer (Thailand) Limited. The funder has no role in the data interpretation, results presentation, and discussion parts of this study.

Disclosures

Prof. Manathip Osiri receives honoraria from Novartis, Pfizer, Sandoz, Viatris and Zuellig Pharma. Piyameth Dilokthornsaku received an honorarium from Pfizer (Thailand) according to this project. Sasitorn Chokboonpium is a Pfizer employee. Pichaya Suthipinijtham is an ex Pfizer employee (during this study developed, the one who created the model for simulation) and a current Boehringer-Ingelheim employee. Ajchara Koolvisoot has nothing to disclose.

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

All the authors have substantially contributed in development of the manuscript by providing critical insights. Study concept and design: MO, AK, SC, PS. Model generation and adaptation: PS, MO, AK, SC, PD. Cost data acquisition: MO, AK. Statistical analysis: PS, PD, SC. Manuscript drafting: MO, AK, SC, PS, PD. Manuscript editing and review: MO, AK, PD, SC. 

Compliance with Ethics Guidelines

The IRB review was waived for this study as it involved in open data from published RCTs and costs input from tertiary care hospitals in Bangkok, Thailand, which can be accessible from general search engines. There was no contact, interview, survey, specimens taken from real patients in this study.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author or author S Chokboonpium (Sasitorn.Chokboonpium@pfizer.com) on reasonable request.

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand

    Manathip Osiri

  2. Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand

    Piyameth Dilokthornsakul

  3. Pfizer (Thailand) Limited, Bangkok, Thailand

    Sasitorn Chokboonpium & Pichaya Suthipinijtham

  4. Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Ajchara Koolvisoot

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  1. Manathip Osiri
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Correspondence to Manathip Osiri.

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Osiri, M., Dilokthornsakul, P., Chokboonpium, S. et al. Budget Impact of Sequential Treatment with Biologics, Biosimilars, and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Thai Patients with Rheumatoid Arthritis. Adv Ther 38, 4885–4899 (2021). https://doi.org/10.1007/s12325-021-01867-8

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