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  4. Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis: a cost-effectiveness analysis compared with adalimumab in Taiwan
 
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Tofacitinib in the treatment of moderate-to-severe rheumatoid arthritis: a cost-effectiveness analysis compared with adalimumab in Taiwan

Journal
Journal of Medical Economics
Journal Volume
22
Journal Issue
8
Pages
777-787
Date Issued
2019
Author(s)
Chen D.-Y.
PING-NING HSU  
Tang C.-H.
Claxton L.
Valluri S.
Gerber R.A.
DOI
10.1080/13696998.2019.1606813
URI
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85066019649&doi=10.1080%2f13696998.2019.1606813&partnerID=40&md5=860ca3eb9d58224431df311238e60911
https://scholars.lib.ntu.edu.tw/handle/123456789/545277
Abstract
Aims: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This analysis investigated the cost-effectiveness of the second-line treatment with tofacitinib, compared with adalimumab, both plus methotrexate (MTX), in patients with moderate-to-severe RA and an inadequate response to the first-line MTX, from a Taiwan National Health Insurance Administration perspective. Materials and methods: A patient-level simulation model was used to project lifetime costs and quality-adjusted life-years (QALYs). Base-case analysis compared second-line treatment with tofacitinib 5 mg twice daily plus MTX vs adalimumab 40 mg every 2 weeks plus MTX. Patients switched or discontinued treatment due to a lack or loss of effectiveness or a serious adverse event. Efficacy was measured by change in Health Assessment Questionnaire-Disability Index (HAQ-DI) score. HAQ-DI scores were used to predict mortality and resource utilization, and were mapped onto utility values to estimate QALYs. Efficacy and safety data were derived from clinical trials and other secondary sources. Uncertainty in model parameters was explored using one-way deterministic and probabilistic sensitivity analyses. Results: Patients gained 0.09 more QALYs with second-line tofacitinib plus MTX compared with adalimumab plus MTX (5.13 vs 5.04, respectively) at an additional cost of New Taiwan Dollars (NT$) 12,881. The incremental cost-effectiveness ratio was NT$143,122/QALY. One-way sensitivity analysis confirmed the base-case result was robust. Limitations: The lack of available clinical data, particularly for HAQ-DI scores, may introduce some bias in the analysis. No patients were in an early stage of RA, which may limit the generalizability of these results. Base-case results from our study are not necessarily generalizable to countries with healthcare systems that differ considerably from Taiwan. Conclusions: From a payer perspective, second-line treatment with tofacitinib plus MTX is a cost-effective treatment strategy, compared with adalimumab plus MTX, in patients with moderate-to-severe RA in Taiwan. ? 2019, ? 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Subjects
Cost-effectiveness; cost-utility; rheumatoid arthritis; Taiwan; tofacitinib
SDGs

[SDGs]SDG3

Other Subjects
adalimumab; methotrexate; tofacitinib; adalimumab; antirheumatic agent; methotrexate; piperidine derivative; pyrimidine derivative; pyrrole derivative; tofacitinib; adult; aged; Article; cohort analysis; controlled study; cost effectiveness analysis; disease severity; drug cost; drug safety; drug substitution; drug withdrawal; European Quality of Life 5 Dimensions questionnaire; female; Health Assessment Questionnaire; health care utilization; hospital mortality; human; major clinical study; male; phase 3 clinical trial (topic); quality adjusted life year; randomized controlled trial (topic); rheumatoid arthritis; sensitivity analysis; simulation; Taiwan; unspecified side effect; adolescent; clinical trial; combination drug therapy; cost benefit analysis; double blind procedure; economic model; economics; middle aged; phase 3 clinical trial; randomized controlled trial; rheumatoid arthritis; severity of illness index; very elderly; young adult; Adalimumab; Adolescent; Adult; Aged; Aged, 80 and over; Antirheumatic Agents; Arthritis, Rheumatoid; Cost-Benefit Analysis; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Methotrexate; Middle Aged; Models, Economic; Piperidines; Pyrimidines; Pyrroles; Quality-Adjusted Life Years; Severity of Illness Index; Taiwan; Young Adult
Publisher
Taylor and Francis Ltd
Type
journal article

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