Economic Evaluation of Treatment Options After Methotrexate for Patients With RA

07/20/18

A recent study assessed the economic effect of tofacitinib after methotrexate compared with tofacitinib after methotrexate and one or two tumor necrosis factor inhibitors (TNFi) for patients with rheumatoid arthritis (RA) from a United States payer perspective.

The study was published in the Journal of Managed Care & Specialty Pharmacy (doi:10.18553/jmcp.2018.17220).

Treatment cycling with biologic disease-modifying anti-rheumatic drugs (ie, TNFi) is common among patients with RA and can result in reduced clinical efficacy as well as increased economic burden.

Lindsay Claxton, MMath, York Health Economics Consortium, University of York (England), and colleagues conducted a study to evaluate the economic effect from a United States payer perspective of tofacitinib (5 mg twice daily) treatment directly after methotrexate in the methotrexate-inadequate responder population, or after methotrexate and one TNFi (adalimumab or etanercept) or two TNFi (adalimumab and etanercept) in TNF-inadequate responder patients with RA.

A decision-tree economic model was utilized to evaluate costs over a 2-year span. Cost inputs included drugs, monitoring and administration, health care utilization, and treatment for adverse events. Economic endpoints were total 2-year costs, costs per patient per month, and costs per American College of Rheumatology 20/50 responder.

Researchers acknowledged that it was assumed that 75% of patients switched therapy after an adverse event or lack of response.

Among the 1321 patients included in the analysis, American College of Rheumatology 20 switch criteria and either 100% of 50% monotherapy rates for all treatments showed 2-year costs and costs per patient per month were lower for those receiving tofacitinib as second-line therapy after methotrexate and as third-line therapy after methotrexate and one TNFi. On the contrary, costs were highest for patients who cycled through two TNFi.

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Researchers noted that similar trends were observed for switch criteria based on American College of Rheumatology 50 response and addition of 20% rebates for adalimumab and etanercept and 0% for tofacitinib, though differences were mitigated slightly.

"A treatment strategy with tofacitinib as either second- or third-line therapy after methotrexate may be a lower cost treatment option, compared with fourth-line introduction of tofacitinib after cycling through two TNFi following methotrexate," authors of the study concluded.—Zachary Bessette