Cost-Effectiveness of Tofacitinib for Patients with Moderate-to-Severe Rheumatoid Arthritis in China

Tian, Lu; Xiong, Xiaomo; Guo, Qiang; Chen, Yixi; Wang, Luying; Dong, Peng; Ma, Anlin

doi:10.1007/s40273-020-00961-z

Cited by 13 publications

(34 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although biologics have developed rapidly and have significantly improved clinical and endoscopic outcomes, their high costs and risk of infections and malignancies limit their application (Bonovas et al, 2016). Recently, new therapies such as biosimilars and small molecular inhibitors have shown promise for application in clinical practice (Brodszky et al, 2014;Navarro et al, 2020;Tian et al, 2020;Vellopoulou et al, 2020). Nevertheless, only limited studies available assessing the effectiveness and tolerance of these drugs are available.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Network Meta-Analysis: Comparative Efficacy and Safety of Biosimilars, Biologics and JAK1 Inhibitors for Active Crohn Disease

Yang

Liu

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

Background: Crohn disease (CD) is a chronic inflammatory disease that affects quality of life. There are several drugs available for the treatment of CD, but their relative efficacy is unknown due to a lack of high-quality head-to-head randomized controlled trials.Aim: To perform a mixed comparison of the efficacy and safety of biosimilars, biologics and JAK1 inhibitors for CD.Methods: We searched PubMed, Web of Science, embase and the Cochrane Library for randomized controlled trials (RCTs) up to Dec. 28, 2020. Only RCTs that compared the efficacy or safety of biosimilars, biologics and JAK1 inhibitors with placebo or another active agent for CD were included in the comparative analysis. Efficacy outcomes were the induction of remission, maintenance of remission and steroid-free remission, and safety outcomes were serious adverse events (AEs) and infections. The Bayesian method was utilized to compare the treatments. The registration number is CRD42020187807.Results: Twenty-eight studies and 29 RCTs were identified in our systematic review. The network meta-analysis demonstrated that infliximab and adalimumab were superior to certolizumab pegol (OR 2.44, 95% CI 1.35–4.97; OR 2.96, 95% CI 1.57–5.40, respectively) and tofacitinib (OR 2.55, 95% CI 1.27–5.97; OR 3.10, 95% CI 1.47–6.52, respectively) and revealed the superiority of CT-P13 compared with placebo (OR 2.90, 95% CI 1.31–7.59) for the induction of remission. Infliximab (OR 7.49, 95% CI 1.85–34.77), adalimumab (OR 10.76, 95% CI 2.61–52.35), certolizumab pegol (OR 4.41, 95% CI 1.10–21.08), vedolizumab (OR 4.99, 95% CI 1.19–25.54) and CT-P13 (OR 10.93, 95% CI 2.10–64.37) were superior to filgotinib for the maintenance of remission. Moreover, infliximab (OR 3.80, 95% CI 1.49–10.23), adalimumab (OR 4.86, 95% CI 1.43–16.95), vedolizumab (OR 2.48, 95% CI 1.21–6.52) and CT-P13 (OR 5.15, 95% CI 1.05–27.58) were superior to placebo for steroid-free remission. Among all treatments, adalimumab ranked highest for the induction of remission, and CT-P13 ranked highest for the maintenance of remission and steroid-free remission.Conclusion: CT-P13 was more efficacious than numerous biological agents and JAK1 inhibitors and should be recommended for the treatment of CD. Further head-to-head RCTs are warranted to compare these drugs.

show abstract

Section: Discussionmentioning

confidence: 99%

Systematic Review and Network Meta-Analysis: Comparative Efficacy and Safety of Biosimilars, Biologics and JAK1 Inhibitors for Active Crohn Disease

Yang

Liu

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…After failure of the first-line treatment, patients were switched to another TNFi (i.e., etanercept) as second-line treatment [25]. After etanercept failure, it was [22] (Fig. 1).…”

Section: Treatment Sequence Of Ra Patientsmentioning

confidence: 99%

“…MTX has not been assessed in China [19,20]. New agents often come with a financial burden, even though they might improve the clinical outcome for patients [21,22]. Therefore, it is necessary to assess the economic value of BCT for patients with moderate-to-severe RA, as BCT was approved by the Chinese National Medical Products Administration (CNMPA) in June 2019.…”

Section: Introductionmentioning

confidence: 99%

“…Although the previous study of Max Schlueter et al indicated that BCT is a cost-effective strategy compared with ADA for Spanish patients with active RA and that of Celine reached the same conclusion for patients with refractory RA in The Netherlands, the cost-effectiveness of BCT + MTX relative to ADA + MTX has not been assessed in China [ 19 , 20 ]. New agents often come with a financial burden, even though they might improve the clinical outcome for patients [ 21 , 22 ]. Therefore, it is necessary to assess the economic value of BCT for patients with moderate-to-severe RA, as BCT was approved by the Chinese National Medical Products Administration (CNMPA) in June 2019.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cost-Effectiveness of Baricitinib for Patients with Moderate-to-Severe Rheumatoid Arthritis After Methotrexate Failed in China

Peng

et al. 2021

Rheumatol Ther

View full text Add to dashboard Cite

Introduction A phase 3 (RA-BEAM study) clinical trial reported that baricitinib (BCT) + methotrexate (MTX) had clinical improvement compared with adalimumab (ADA) + MTX as a first-line strategy in patients with rheumatoid arthritis (RA) who had inadequate responses to MTX monotherapy. However, from the perspective of the Chinese healthcare system, the cost-effectiveness of introducing BCT into current treatment for patients with RA unresponsive to MTX remains unclear. Methods A patient-level microsimulation model was used to extrapolate the lifetime incremental cost per quality-adjusted life-year (QALY) and other outcomes. This study compared treatment sequences with or without first-line BCT with current treatment sequences, including adalimumab, etanercept, tocilizumab, and palliative care. Effectiveness and physical function were assessed using the American College of Rheumatology (ACR) 20/50/70 response and Health Assessment Questionnaire (HAQ). The input parameters of the model, comprising patient characteristics (sex and age) and treatment efficacy (ACR responses and HAQ score), were derived from a phase III clinical trial and network meta-analysis. The total cost estimation included direct costs and indirect costs. Probabilistic and univariate sensitivity analyses were performed, as were a series of scenario analyses. Results The lifetime analysis revealed that adding BCT as a first-line treatment resulted in a QALY gain of 2.66 years; this gain would cost an incremental $26,662, leading to an incremental cost-effectiveness ratio of $10,036/QALY per patient compared with the current treatment sequence. Sensitivity and scenario analyses showed the results to be robust. Conclusions From a Chinese payer perspective, the introduction of BCT into the current treatment sequence is projected to be a cost-effective option as first-, second-, third-, and fourth-line treatment for patients with moderate-to-severe RA. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00308-w.

show abstract

“…The average expense of patients in the hospital per day was derived from a study by Wu et al [47]. We assumed that the cost of AE management was the same across different tDMARDs and equal to the cost of treating pneumonia ($1761.4), according to Tian et al [48]. All costs in this study were converted into 2019 US dollars (1 USD = 6.83 RMB), and the Chinese consumer price index was also used to adjust the costs from past sources to 2019 USD [49].…”

Section: Cost and Utility Estimatesmentioning

confidence: 99%

Cost-effectiveness of Triple Therapy vs. Biologic Treatment Sequence as First-line Therapy for Rheumatoid Arthritis Patients after Methotrexate Failure

Peng

et al. 2021

Rheumatol Ther

View full text Add to dashboard Cite

Introduction: A clinical trial (RACAT) reported the noninferiority of triple therapy compared to biologic agents (etanercept ? methotrexate), and previous studies confirmed that biologic disease-modifying antirheumatic drugs (bDMARDs) are more expensive but less beneficial than triple therapy for patients with rheumatoid arthritis (RA) in whom methotrexate (MTX) fails. However, from the perspective of the Chinese healthcare system, the cost-effectiveness of triple therapy versus bDMARD treatment sequences as a first-line therapy for patients with RA is still unclear. Methods: An individual patient simulation model was used to extrapolate the lifetime cost and health outcomes by tracing patients from initial treatment through switches to further treatment lines in a sequence. Therapeutic efficacy and physical function were evaluated using the American College of Rheumatology (ACR) response, 28-Joint Disease Activity Score (DAS28), and Health Assessment Questionnaire score. All input parameters in the model were derived from published studies, national databases, local hospitals, and experts' opinions. Both direct costs and indirect costs were taken into consideration. Probabilistic and one-way sensitivity analyses were performed to test the uncertainty of the model, as were multiple scenario analyses. Results: The lifetime analysis demonstrated that triple therapy was associated with lower costs and quality-adjusted life years (QALYs) than bDMARD sequences. These resulted in incremental cost-effectiveness ratios (ICERs)

show abstract

Cost-Effectiveness of Tofacitinib for Patients with Moderate-to-Severe Rheumatoid Arthritis in China

Cited by 13 publications

References 39 publications

Systematic Review and Network Meta-Analysis: Comparative Efficacy and Safety of Biosimilars, Biologics and JAK1 Inhibitors for Active Crohn Disease

Systematic Review and Network Meta-Analysis: Comparative Efficacy and Safety of Biosimilars, Biologics and JAK1 Inhibitors for Active Crohn Disease

Cost-Effectiveness of Baricitinib for Patients with Moderate-to-Severe Rheumatoid Arthritis After Methotrexate Failed in China

Cost-effectiveness of Triple Therapy vs. Biologic Treatment Sequence as First-line Therapy for Rheumatoid Arthritis Patients after Methotrexate Failure

Contact Info

Product

Resources

About