Decision Resources Group, London, United Kingdom.
Pfizer Inc, Groton, Connecticut.
J Manag Care Spec Pharm. 2020 Aug;26(8):1027-1038. doi: 10.18553/jmcp.2020.19319. Epub 2020 Apr 20.
Psoriatic arthritis (PsA) is a chronic progressive inflammatory condition associated with significant direct and indirect costs. Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA. Economic evaluations, alongside clinical data, help inform papers and formulary decisions in the United States.
To evaluate outcomes and costs of including tofacitinib in treatment strategies for PsA from a third-party U.S. payer perspective, using a health economic model.
A decision tree model was developed to evaluate treatment sequences (up to 4 lines of advanced PsA therapy) with or without tofacitinib. Patients included in the model had active PsA and a previous inadequate response (IR) to conventional synthetic disease-modifying antirheumatic drug (csDMARD) or tumor necrosis factor inhibitor (TNFi) therapy. The analysis time horizon was 2 years; decision points for continuing/switching treatments occurred quarterly, based on clinical response (assessed using the primary rheumatoid measure of efficacy, American College of Rheumatology [ACR]20 response only) and adverse drug reactions (ADRs). Costs included those related to ADRs and drug acquisition, monitoring, and administration. Other endpoints of PsA, such as assessment of enthesitis and dactylitis, were not integrated into the model.
Treatment strategies including tofacitinib were associated with cost savings versus strategies without tofacitinib across all modeled scenarios, with an estimated 2-year cost saving of up to $8,454,858, based on 1 million insurants. Similarly, costs per member per month and per ACR20 responder were lower for sequences including tofacitinib versus sequences without. These savings arose because of lower ADR and drug acquisition/administration costs for sequences including tofacitinib. Deterministic sensitivity analyses showed these results to be robust.
This analysis suggests that including tofacitinib in the treatment of active PsA in csDMARD-IR or TNFi-IR patients is a cost-saving alternative to sequences without tofacitinib, potentially reducing costs for PsA advanced therapies by up to $8.4 million over 2 years for payers insuring 1 million individuals.
This work was sponsored by Pfizer Inc. Bungey is an employee of Decision Resources Group, which received financial support from Pfizer Inc to develop the treatment-cost model used in the development of this manuscript. Chang-Douglass was an employee of Decision Resources Group at the time of the analysis. During development of this publication, Chang-Douglass started a role at the National Institute for Health and Care Excellence (NICE). The publication only reflects her views and does not reflect the views of NICE. Hsu, Cappelleri, Young, and Woolcott are employees of Pfizer Inc and own stock or stock options in Pfizer Inc. The data reported in this manuscript have been previously presented at the American College of Rheumatology Annual Scientific Meeting; October 19-24, 2018; Chicago, IL, and the AMCP Annual Meeting and Expo; March 25-28, 2019; San Diego, CA.
银屑病关节炎（PsA）是一种慢性进行性炎症性疾病，与巨大的直接和间接成本相关。托法替布是一种用于治疗 PsA 的口服 Janus 激酶抑制剂。经济学评价与临床数据共同为美国的论文和处方集决策提供信息。
从美国第三方支付者的角度，通过健康经济学模型，评估将托法替布纳入 PsA 治疗方案的结果和成本。
开发了一个决策树模型，以评估有无托法替布的治疗方案（最多 4 线高级 PsA 治疗）。纳入模型的患者患有活动性 PsA 且先前对传统合成改善病情抗风湿药（csDMARD）或肿瘤坏死因子抑制剂（TNFi）治疗应答不足（IR）。分析时间范围为 2 年；根据临床应答（仅使用美国风湿病学会 [ACR]20 应答的主要类风湿疗效指标评估）和药物不良反应（ADR），每季度进行一次继续/转换治疗的决策点。成本包括与 ADR 和药物获取、监测及管理相关的成本。模型未纳入其他 PsA 结局，如附着点炎和指（趾）炎的评估。
与不包含托法替布的方案相比，所有模型情景中包含托法替布的治疗方案均具有成本节约，基于 100 万被保险人，2 年的预计成本节约高达 845.4858 万美元。同样，包含托法替布的方案中，每个成员每月和每个 ACR20 应答者的成本也更低。这些节约源于包含托法替布的方案中 ADR 和药物获取/管理成本更低。确定性敏感性分析表明，这些结果是稳健的。
该分析表明，对于 csDMARD-IR 或 TNFi-IR 患者的活动性 PsA，包含托法替布的治疗方案是一种比不包含托法替布的方案更具成本效益的替代方案，在 2 年内，支付者为 100 万个人承保，包含托法替布的方案可使 PsA 高级治疗方案的成本降低高达 840 万美元。
本项工作由辉瑞公司赞助。Bungey 是 Decision Resources Group 的员工，Decision Resources Group 从辉瑞公司获得了开发用于本研究手稿的治疗成本模型的资金支持。Chang-Douglass 在进行分析时是 Decision Resources Group 的员工。在本出版物的开发过程中，Chang-Douglass 开始在英国国家卫生与临床优化研究所（NICE）任职。该出版物仅反映了她的观点，并不反映 NICE 的观点。Hsu、Cappelleri、Young 和 Woolcott 是辉瑞公司的员工，拥有辉瑞公司的股票或股票期权。本研究报告中报告的数据此前已在 2018 年 10 月 19-24 日在芝加哥举行的美国风湿病学会年度科学会议和 2019 年 3 月 25-28 日在圣地亚哥举行的 AMCP 年会和博览会上展示。
