Comparison cost per clinical remission of Janus kinase inhibitors (JAKi) therapies in the treatment of rheumatoid arthritis in Argentina

Autores: Jorge F. Elgart, David Zelaya, Pablo Bernztein, Diego Kanevsky, Micaela Cosatti, Alejandro J. Brigante, Anastasia Secco

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Introduction:
Little is known about the cost per response of Janus kinase inhibitors (JAKi) for the treatment of rheumatoid arthritis (RA).

Objectives:
Estimate the incremental cost per remission (CpR) for JAKi in patients with moderate to severe RA who had an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in Argentina.

Materials and methods:
A model combining remission rates (defined as DAS28-CRP <2.6) and treatment costs was used. Efficacy data (% remission) were obtained from a published network meta-analysis comparing JAKi in RA. Treatment costs were estimated based on the approved doses of each original drug, and prices obtained from Alfabeta.net. Incremental CpR with respect to csDMARD was calculated as the ratio between the incremental cost of the treatment of interest and the incremental efficacy rate.

Results:
At 12 weeks the CpR were: upadacitinib (15 mg) + csDMARD ($30,641,221), tofacitinib (5 mg) + csDMARD ($34,513,867), baracitinib (4 mg) + csDMARD ($45,697,728) and baracitinib (2 mg) + csDMARD ($54,574,265). While at 24 weeks the CpR were: $44,093,465 for upadacitinib (15 mg) + csDMARD, $62,952,886 for baracitinib (4 mg) + csDMARD, $79,850,766 for baracitinib (2 mg) + csDMARD and $173,528,054 for tofacitinib (5 mg) + csDMARD.

Conclusions:
The results suggest that among JAKi therapies for the treatment of patients with moderate to severe csDMARD-IR RA in Argentina, upadacitinib would have the lowest incremental CpR.