Economic Evaluation of Tofacitinib as Initial Medication In Adults With Rheumatoid Arthritis After Failure to Methotrexate In Chile

Abstract

OBJECTIVES: Condoliase, an enzyme that specifically degrades glycosaminoglycans, main constituents of the nucleus pulposus, and reduces the compressions on nerves, can serve as a less-invasive curative treatment for patients with lumbar disc herniation and is expected to reduce associated medical cost due to shortened hospital stays. This study aims to evaluate the cost-effectiveness of the treatment with condoliase compared with conventional surgical therapy in the Japanese healthcare system. METHODS: A Markov model was developed to estimate quality-adjusted life year (QALY) and associated costs over 1 year. QOL scores were converted from corresponding Oswestry Disability Index (ODI). ODI of condoliase group came from the results of a phase 3, multicenter, double-blind, randomized placebo-controlled study conducted in Japan. ODI of surgery group was estimated from the values obtained from published literatures. The risk of re-operation after treatment was considered during calculation. Surgical treatment costs and re-operation costs were collected and estimated using a Japanese administrative claims database (Japan Medical Data Center, JMDC). Payer perspective was adopted, and discounting was not applied due to the short timeframe of the analysis. One-way sensitivity analysis was performed to assess the impact of parameter uncertainty on the model's conclusion. RESULTS: Average cost and effectiveness gained per patient for condoliase group and surgery group were 385,344 JPY vs. 798,919 JPY, 0.694 QALY vs. 0.685 QALY, respectively, meaning condoliase group was dominant compared to surgery group. One-way sensitivity analysis showed the robustness of this result. CONCLUSIONS: From the payer perspective, treatment with condoliase for patients with lumbar disc herniation in Japan is expected to reduce medical costs compared to conventional surgery treatment even taking into account the uncertainties.OBJECTIVES: Rheumatoid Arthritis (RA) destroys synovial joints and generates pain. Its prevalence in Chile has been estimated to be 0.46% (IC 95% 0.24-0.8). Available drugs for treatment include conventional synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs), biological therapies and a new drug approved for treatment after failure of csDMARDs: tofacitinib. The aim of this study is to compare the costs-effectiveness of tofacitinib relative to biological therapies as an initial treatment in adults with RA after failure of methotrexate in Chile. METHODS: A simulation model of individual patients compared two treatment sequences for RA: tofacitinib vs biological therapy as initial medications; always assuming a combination therapy with methotrexate; biological therapies validated with rheumatologists and included in the model were etanercept, infliximab, tocilizumab, adalimumab, rituximab and salvage therapy (defined by experts). The characteristics of the patient included: age, weight, initial HAQ score, and clinical response to short and long term treatment. HAQ scores were used to calculate utilities, measured in Q...