Comparing cost per clinical remission of Janus Kinase Inhibitors (JAKi) therapies in the treatment of rheumatoid arthritis in Argentina

ELGART, JORGE; BRITOS, MARIA; CALVI, G; KANEVSKY, D; SECCO, A

Congreso; XXV Congreso Panamericano de Reumatologia; 2023

PANLAR

Objectives: Janus kinase inhibitors (JAKi) are a class of targeted therapies for rheumatoid arthritis (RA) with established clinical efficacy. However, little is known about the cost per response of these therapies compared to each other. This study estimates the incremental cost per remission (CpR) [DAS28-CRP] for JAKi in patients with moderate to severe RAwho had inadequate response to conventional synthetic disease modifying antirheumatic drugs (csDMARD) in Argentina.Methods: Using a model developed in Excel, which combines clinical remission rates (defined as DAS28 < 2.6) and treatment costs, we estimated the CpR of the following JAKi treatments available in Argentina: baricitinib (BAR), tofacitinib (TOF) and upadacitinib (UPA). The analysis considers CpR at 12 and 24 weeks according to the timeframe used to assess efficacy outcomes in clinical trials for RA. Efficacy inputs (% remission) for comparing JAKi with csDMARD were obtained from a published network meta-analysis. Costs of treatments (considering JAKi with csDMARD) were estimated based on approved regimens and doses of each original drug as well as drug prices obtained from a publicly available price list. The incremental CpR compared to csDMARD was calculated as the incremental cost of treatment of interest divided by the incremental efficacy rate. Incremental CpR are expressed in Argentinean Pesos ($) (exchange rate 1US$ = 173.75$, Nov 2022). Results: At 12 weeks, the remission rates for these therapies were: UPA 15 mg 32.3%; BAR 4 mg 25.3%; TOF 5 mg 24.4%; BAR 2 mg 22.3%; and csDMARD 7.1%. At the same time, the treatment costs were: UPA 15 mg $531,877; BAR (2 or 4 mg) $584,946; TOF 5 mg $612,902; and csDMARD $13,168. UPA treatment showed the lowest incremental CpR (Figure 1). Considering clinical remission at 24 weeks, UPAyielded lower treatment costs than BAR and TOF (Table 1). The incremental CpR were, in increasing order: UPA 15 mg $3,015,750; BAR 4 mg $4,467,014; BAR 2 mg $5,633,278; and TOF 5 mg $15,377,801. Conclusion: The results suggest that in Argentina among JAKi therapies for the treatment of patients with moderate to severe RAwho were inadequate responders to csDMARD- , UPAwould have the lowest incremental CpR.