Session Information
Date: Sunday, November 8, 2015
Title: Health Services Research Poster I: Diagnosis, Management and Treatment Strategies
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Tofacitinib
is an oral Janus kinase (JAK) inhibitor for the treatment of rheumatoid arthritis
(RA). An economic model was developed to evaluate the treatment costs of an RA strategy,
including tofacitinib compared with strategies of biologic therapies that are
commonly prescribed in the US. The model aimed to address the economic impact
of monotherapy and combination therapy in MTX-inadequate responder (IR)
patients and combination therapy in TNFi-IR patients.
Methods: A
decision-tree economic model was developed to evaluate costs over a one- or two-year
time horizon. The model assessed patients with
moderate to severe RA undergoing treatment with
tofacitinib
5 mg BID or similarly labeled biologic therapies, either
as monotherapy or with methotrexate (MTX), in scenarios where patients had an
inadequate response to MTX therapy or after a first TNFi
failure (combination therapy only). Response to treatment was modeled as ACR20/50/70
response. ACR response rates at 6‑month
intervals were sourced from US Prescribing Information, and safety event rates
from a meta-analysis. Following an adverse event or a lack of
response, it was assumed that 75% of patients switched to the next line of
treatment (first to abatacept, and then to rituximab). Cost inputs included
drug, monitoring, drug administration, and treatment for minor and serious
adverse events. The patient population was based on the total number of all members
(i.e. RA and non RA) in an organization; members with RA treated with biologic
therapies were estimated using epidemiological data. The economic endpoints
were: cost per member per month (PMPM), cost
per ACR20 responder, and total costs. Sensitivity analysis
adjusted for absolute ACR20 rates (lowering for tofacitinib and increasing for
biologics).
Results: Results
based on an organization size of 1 million with MTX-IR patients (n=1505) and
TNFi-IR patients (n=602) are presented in Table 1. In the MTX-IR population, the
monotherapy strategy with tofacitinib alone was associated with the lowest PMPM,
cost per ACR20 responder and total costs over 1 and 2 years compared with the TNFi
and non-TNFi biologics. Similar results
were observed for combination therapy. In the TNFi-IR population, tofacitinib
+ MTX was associated with a lower PMPM, cost per ACR20 responder and total
costs over 1 and 2 years compared with adalimumab + MTX. Tofacitinib strategies
with no rebate (0%) were still associated with lower costs compared with
adalimumab and etanercept with 20% rebates. Lower costs with tofacitinib were
supported by sensitivity analysis.
|
Table 1: Economic model results (sorted lowest to highest cost based on two-year total costs) |
||||||
|
|
Cost PMPM |
Cost per ACR20 responder |
Total costs |
|||
|
|
One year |
Two years |
One year |
Two years |
One year |
Two years |
|
MTX-IR patients |
||||||
|
Tofacitinib monotherapy |
$4.09 |
$4.38 |
$47,830 |
$96,381 |
$49,066,725 |
$105,103,278 |
|
Tofacitinib + MTX |
$4.21 |
$4.50 |
$57,973 |
$111,334 |
$50,510,949 |
$107,966,327 |
|
Tocilizumab monotherapy |
$4.79 |
$5.01 |
$56,536 |
$111,104 |
$57,451,755 |
$120,319,824 |
|
Tocilizumab + MTX |
$4.85 |
$5.03 |
$67,342 |
$125,179 |
$58,232,653 |
$120,752,673 |
|
Certolizumab monotherapy |
$5.09 |
$5.22 |
$73,974 |
$134,103 |
$61,079,342 |
$125,271,312 |
|
Certolizumab + MTX |
$5.10 |
$5.27 |
$65,748 |
$124,384 |
$61,230,332 |
$126,452,249 |
|
Etanercept monotherapy |
$5.25 |
$5.41 |
$66,813 |
$126,544 |
$63,056,328 |
$129,880,666 |
|
Adalimumab monotherapy |
$5.34 |
$5.41 |
$78,393 |
$140,025 |
$64,082,494 |
$129,901,536 |
|
Etanercept + MTX |
$5.28 |
$5.48 |
$60,823 |
$119,203 |
$63,332,567 |
$131,423,554 |
|
Adalimumab + MTX |
$5.37 |
$5.50 |
$67,805 |
$128,061 |
$64,428,338 |
$132,081,552 |
|
TNFi-IR patients |
||||||
|
Tofacitinib + MTX |
$1.68 |
$1.80 |
$57,492 |
$110,596 |
$20,180,138 |
$43,127,524 |
|
Adalimumab + MTX |
$2.15 |
$2.18 |
$77,344 |
$138,937 |
$25,753,046 |
$52,222,968 |
Conclusion: Tofacitinib
5 mg BID following MTX failure is predicted to be a low
cost per patient treatment option when used either as monotherapy or combination
therapy compared with biologic regimens. Tofacitinib + MTX
in TNFi-IR patients was also predicted to be a
low cost treatment option compared with adalimumab + MTX. Tofacitinib
was associated with the lowest cost per
ACR20 response.
To cite this abstract in AMA style:
Claxton L, Taylor M, Jenks M, Wallenstein G, Mendelsohn A, Bourret J, Singh A, Gerber R. An Economic Evaluation of Tofacitinib (Xeljanz) Treatment in Rheumatoid Arthritis: Modeling the Cost of Treatment Strategies in the US [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/an-economic-evaluation-of-tofacitinib-xeljanz-treatment-in-rheumatoid-arthritis-modeling-the-cost-of-treatment-strategies-in-the-us/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-economic-evaluation-of-tofacitinib-xeljanz-treatment-in-rheumatoid-arthritis-modeling-the-cost-of-treatment-strategies-in-the-us/