Fatemi Behzad, Yaghoubi Neda, Shobeiri Nikta, Ahmadi Razieh, Mousavi Taraneh, Soleymani Fatemeh, Rezaei Soheila
Pharmaceutical Management and Economics Research Center (PMERC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.
Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Expert Rev Pharmacoecon Outcomes Res. 2025 Jan;25(1):29-38. doi: 10.1080/14737167.2024.2390041. Epub 2024 Aug 11.
As rheumatoid arthritis (RA) is a chronic and progressive disease that requires lifelong therapeutic intervention, it represents a considerable economic burden on those affected. This study investigated whether tofacitinib is a cost-effective therapeutic alternative to other DMARDs for treating moderate-to-severe RA.
All economic evaluation studies of tofacitinib compared to other DMARDs were identified. Using random-effects meta-analysis, we pooled incremental net benefit (INB) in (purchasing power parity) adjusted US$ with 95% confidence intervals. The modified economic evaluation bias checklist and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) instrument for quality appraisal were used. The subgroup analysis was done based on the comparator regimen.
Of the selected 11 studies, the number of studies from high-, upper-middle- and lower-middle-income countries was 7, 3, and 1, respectively. The subgroup analysis showed that tofacitinib with an INB of 19,180 US$ [95% CI, -34520 to -3840; p-value = 0.01] was not statistically cost-effective compared with cDMARDs (p-value > 0.0001). Compared to other DMARDs, the estimated pooled INB of tofacitinib was US$ 7260 [95% CI, 3030 to 11,480; p-value < 0.001], but there was substantial heterogeneity among the included studies, and the observed publication bias.
While tofacitinib shows potential as a cost-effective treatment, tailored economic evaluations are needed to account for the diverse and evolving contexts of RA treatment.
PROSPERO: CRD42023405970.
类风湿性关节炎（RA）是一种需要终身治疗干预的慢性进行性疾病，给患者带来了相当大的经济负担。本研究调查了托法替布在治疗中重度RA方面是否是一种比其他改善病情抗风湿药（DMARDs）更具成本效益的治疗选择。
检索了所有比较托法替布与其他DMARDs的经济学评价研究。采用随机效应荟萃分析，汇总了经购买力平价调整后的美元增量净效益（INB）及其95%置信区间。使用了经修改的经济学评价偏倚清单和推荐分级、评估、制定与评价（GRADE）工具进行质量评估。根据对照方案进行亚组分析。
在所选的11项研究中，来自高收入、中高收入和中低收入国家的研究数量分别为7项、3项和1项。亚组分析显示，与传统合成DMARDs（cDMARDs）相比，托法替布的INB为19,180美元[95%置信区间，-34520至-3840；p值 = 0.01]，在统计学上不具有成本效益（p值>0.0001）。与其他DMARDs相比，托法替布的估计汇总INB为7260美元[95%置信区间，3030至11,480；p值<0.001]，但纳入研究之间存在显著异质性，且存在明显的发表偏倚。
虽然托法替布显示出作为一种具有成本效益的治疗方法的潜力，但需要进行针对性的经济学评价，以考虑RA治疗的多样化和不断变化的背景。
国际前瞻性系统评价注册库（PROSPERO）：CRD42023405970
