Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
Adv Ther. 2021 Sep;38(9):4885-4899. doi: 10.1007/s12325-021-01867-8. Epub 2021 Aug 9.
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.
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.
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.
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.
类风湿关节炎（RA）的靶向治疗包括生物 DMARDs（bDMARDs）和 JAK 抑制剂（JAKi）。基于疗效和安全性数据，这些药物被推荐在同一级别使用。然而，迄今为止，尚无关于 RA 治疗方案对总预算支出影响的本地证据。本研究旨在探讨在至少三种传统合成 DMARD 治疗失败的泰国 RA 患者中，不同序贯靶向治疗方案的预算影响。
我们使用改编后的模型来评估依那西普、英夫利昔单抗（IFX）、戈利木单抗（GOL）、利妥昔单抗（RTX）、托珠单抗（TCZ）静脉制剂）、两种 JAKi [托法替尼（TOF）和巴瑞替尼（BAR）]和两种 IFX 生物类似物（PF-06438179/GP1111 和 CT-P13）。总共生成了 80 种治疗序列，每种治疗序列包含四种连续的一线、二线、三线和四线选择。
基础方案情景的结果表明，以 RTX 为一线治疗，其次是 IFX 生物类似物（PF-06438179/GP1111）、TOF 和 TCZ 的治疗方案产生的预算影响最低，为 69354 万美元。敏感性分析证实了我们研究结果的稳健性。
以 RTX 为起始的靶向治疗序贯方案，然后是 IFX 生物类似物、TOF，最后是 TCZ，在 5 年内治疗中重度 RA 的预算影响最低。我们的研究结果可能有助于支付者和决策者考虑对慢性非传染性疾病（尤其是 RA）进行适当的预算分配。
