THU0187 EFFICIENCY OF TREATMENT SEQUENCES CONTAINING TOFACITINIB FOR RHEUMATOID ARTHRITIS IN SPAIN
Authors: Carmen Peral, Alejandro Balsa, Federico Navarro, José Luis Pablos, Jose Manuel Martinez Sesmero, Susana Gómez, Monica Valderrama, Itziar Oyagüez, Miguel Angel Casado, Fernando De Andres, Maria Montoro
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The availability of oral janus kinase inhibitors, as tofacitinib, has extended the treatment pathways for management of patients with rheumatoid arthritis (RA) <h3>Objectives:</h3> To assess the cost-effectiveness of tofacitinib as second-line treatment compared to treatment sequences containing standard biological-therapies in patients with moderate to severe RA after failure to disease-modifying antirheumatic drugs (DMARDs) from the Spanish National Health System perspective. <h3>Methods:</h3> A patient-level microsimulation model was used to compare the lifetime cost and quality-adjusted life-years (QALY) for treatment sequences initiating with tofacitinib (5mg BID) followed by biological therapies versus sequences of biological treatments excluding tofacitinib. The sequences were selected by a panel of experts based on clinical practice in Spain. Concomitant treatment with methotrexate (MTX) was considered along all the therapies in the treatment sequences. Model parameters included age, weight, initial Health Assessment Questionnaire (HAQ) score and clinical response to short and long treatment. Efficacy was measured by means of HAQ score changes using mixed-treatment-comparisons (for the first 6 months) and data from long-term extension trials (for later periods). Serious adverse event (SAE) information derived from literature. The estimation of total cost for sequences included: drugs acquisition (public ex-factory prices with mandatory deduction or reference prices) and parenteral administration, disease progression and SAE management. Local unitary costs (€, 2018) were applied. Additional comparisons were explored testing other potential sequences. <h3>Results:</h3> The base case results showed that sequences initiating with tofacitinib provided greater outcomes than the correspondent sequences excluding tofacitinib. In scenario 1 tofacitinib+MTX→Rituximab+MTX→sc Tocilizumab+MTX→Etanercept+MTX→Certolizumab+MTX provided 13.99 QALYs versus 13.92 QALYs for adalimumab+MTX→Rituximab+MTX→sc Tocilizumab+MTX→Etanercept+MTX→Certolizumab+MTX. In scenario 2 tofacitinib+MTX→Adalimumab+MTX→Rituximab+MTX→sc Tocilizumab+MTX→Etanercept+MTX provided 13.75 QALYs versus 13.62 QALYs for Baricitinib+MTX→Adalimumab+MTX→Rituximab+MTX→sc Tocilizumab+MTX→Etanercept+MTX. Tofacitinib-containing sequences provided lower total costs than the alternative sequences (-€5,783 and -€13,975 for the pairwise comparisons previously described), resulting, therefore, dominant options versus sequences excluding tofacitinib. On the probabilistic sensitivity analyses, sequences initiating with tofacitinib resulted cost-effective in 64.0% (scenario 1) and 56.9% (scenario 2) of the 1,000 iterations performed, because incremental cost-effectiveness ratio fell below a €25,000/QALY gained willingness to pay threshold. <h3>Conclusion:</h3> These results suggest that the inclusion of tofacitinib could be a dominant strategy for treatment of moderate to severe RA patients after DMARDs failure in Spain. <h3>Disclosure of Interests:</h3> Carmen Peral Shareholder of: Carmen Peral is employee of and shareholder in Pfizer, Employee of: Carmen Peral is employee of and shareholder in Pfizer, Alejandro Balsa Grant/research support from: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Consultant for: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Sandoz, Lilly, Paid instructor for: Pfizer, Speakers bureau: Pfizer, Novartis, UCB, Nordic, Sanofi, Sandoz, Lilly, Federico Navarro Grant/research support from: Pfizer, Consultant for: Pfizer, José Luis Pablos: None declared, Jose Manuel Martinez Sesmero Consultant for: Pfizer, Susana Gómez Employee of: I am a current employee of Pfizer., Monica Valderrama Shareholder of: Have received shares from Pfizer, Employee of: employee in Pfizer, Itziar Oyagüez Consultant for: I am employee of PORIB a consultant company which has received financial support from Grünenthal for development of this project, Miguel Angel Casado Grant/research support from: Pfizer, Consultant for: Pfizer, Fernando De Andres Grant/research support from: Pfizer, Employee of: Pfizer, Maria Montoro Shareholder of: Maria Montoro is employee of and shareholder in Pfizer, Employee of: Maria Montoro is employee of and shareholder in Pfizer