Janus kinase (JAK) inhibitors are new oral drugs with proven efficacy in rheumatoid arthritis (RA). Currently, three JAK inhibitors, that is, tofacitinib, baricitinib and upadacitinib, are approved for clinical use in Russia.
To assess the cost-effectiveness of JAK inhibitors in combination with conventional synthetic disease-modifying antirheumatic drug (csDMARD) for the treatment of RA and to conduct the budget impact analysis of more frequent use of JAK inhibitors in clinical practice.
Material and methods
The cost-effectiveness was evaluated from the payer's perspective for a population of patients with inadequate response to csDMARDs based on the results of a network meta-analysis of RCTs. The quality-adjusted lifeyears (QALYs) were calculated using the rates of clinical response (ACR20, ACR50, and ACR70) and remission (DAS28-CRP) and were used as criteria for clinical effectiveness. The time horizon of the analysis was 24 weeks. For the budget impact analysis we used published data from a pharmacoepidemiological study with a horizon of 4 years. The cost of upadacitinib therapy was calculated based on the planned registration price (38245,97 rubles per pack # 28), and the costs of biological disease modifying anti-rheumatic drugs (bDMARDs), tofacitinib and baricitinib therapy were calculated based on the registered prices. In all cases, VAT and the weighted average marginal wholesale mark-up for the Russian Federation (11.61%) were taken into account. The analysis was carried out without discounting.
In the base case, upadacitinib was more costeffective than tofacitinib and baricitinib. The cost per 1 additional QALY for upadacitinib therapy is 16.9% less than for baricitinib therapy and 26.8% less than for tofacitinib therapy. The cost per 1 additional remission with upadacitinib therapy is 30.2% lower than with baricitinib therapy and 45.0% lower than with tofacitinib therapy. Budget impact analysis showed that the use of JAK inhibitors will reduce the costs by 3.5% compared to current therapy, and annual cost savings will increase with an increase in the proportion of patients receiving these medications.
Our modeling study suggests that the combination of upadacitinib with csDMARD (methotrexate) is characterized by a higher cost-effectiveness compared to the combination of csDMARD with tofacitinib and baricitinib. More frequent use of JAK inhibitors will not increase the burden on the health care budget.
Rheumatoid arthritis, JAK Inhibitors, biological disease modifying anti-rheumatic drugs, conventional synthetic disease-modifying anti-rheumatic drugs, cost effectiveness, budget impact analysis.