Comparative Analysis on Cost-Effectiveness of Tofacitinib Versus Baricitinib in the Treatment of Rheumatoid Arthritis
Objective To compare the economy of tofacitinib versus baricitinib in the treatment of rheumatoid arthritis(RA).Methods Based on China's healthcare system,the head to head real-world researches comparing the clinical efficacy of baricitinib versus tofacitinib were obtained,the prices of the two drugs were obtained from the website(https://www.scyxzbcg.cn),a decision tree model was constructed by the TreeAge Pro 2011 software,the incremental cost-effectiveness ratio(ICER)was calculated,the scenario analysis,one-way sensitivity analysis and probability sensitivity analysis were performed to compare the economy of two drugs.Results With clinical remission(clinical disease activity index(CDAI)≤2.8 points)rate or reaching rate of low disease activity(2.8 points<CDAI≤10 points,LDA)as the outcome indicator,the ICER of baricitinib compared to tofacitinib were 27574.21488 and 27125.85366,respectively.The one-way sensitivity analysis showed that the cost and remission rate of baricitinib had a significant effect on the outcomes with the remission rate of the two drugs as the outcome indicator;the cost of baricitinib and LDA reaching rate of the two drugs had a significant effect on the outcomes with the LDA reaching rate as the outcome indicator.The cost of tofacitinib had a little effect on the outcomes.When considering both the original-patented and the generic drugs(both tofacitinib and baricitinib reaching remission and LDA in clinical efficacy),the ICERs of baricitinib compared to tofacitinib were 67221.74 and 66128.70,respectively.The cost-effectiveness acceptable curve in probability sensitivity analysis showed that when the willingness to pay(WTP)per unit effect was 0,tofacitinib was optimal,with the cost-effectiveness probability of 100%;when the clinical remission rate and LDA reaching rate were taken as the outcome indicators,baricitinib was optimal,with the WTP per unit effect were greater than CNY 28766 and CNY 24743,respectively.Conclusion When comparing the economy of tofacitinib versus baricitinib in the treatment of RA,different outcome indicators and WTPs should be considered.
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