■为了评估upadacitinib(靶向合成疾病改善抗风湿药[ts-DMARD])作为一线(1L)治疗与目前治疗在沙特阿拉伯王国(KSA)的类风湿关节炎(RA)患者的成本效益,对先前的常规合成(csDMARDs)和/或生物DMARDs(bDMARDs)反应不足。
该基于Excel的模型包括中度(疾病活动评分[DAS28]:>3.2至≤5.1)或重度RA(DAS28>5.1)的患者。将当前治疗的成本效益(1L:阿达木单抗起源/生物仿制药;二线(2L):其他bDMARDs/托法替尼)与涉及两种情况的新疗法(1L:upadacitinib,2L:阿达木单抗-生物仿制药[情景-1]/阿达木单抗-发起人[情景-2])从社会角度来看,为期10年。模型结果包括直接成本和间接成本,质量调整寿命年(QALYs),住院天数,骨科手术的数量,和每个QALY的增量成本效用比(ICUR)。
■根据当前途径,100例RA患者在10年期间的估计社会总费用为沙特里亚尔(SAR)50,450,354(13,453,428美元)(中度RA)和SAR50,013,945(13,337,052美元)(重度RA).新的途径(情景-1)表明,在中度至重度RA患者中,upadacitinib以较低的社会成本(成本差异:-SAR2,023,522[-USD539,606]和-SAR3,373,029[-USD899,474],导致更高的QALY收益(+8.99和+15.63),分别)。因此,作为1L,upadacitinib预测“显性”ICUR每个QALY超过当前途径。此外,在替代途径(方案2)中,upadacitinib还预测重度RA患者每QALY的“显性”ICUR(QALY增益:+15.63;成本差异:-SAR164,536[-USD43,876])。然而,中度RA与改善QALY(+8.99)超过当前途径(ICURperQALY:SAR139,742[USD37,264])的额外成本SAR1,255,696(USD334,852)相关。两种方案均导致在当前治疗途径中,中重度RA的住院天数减少(方案1:-14.83天;方案2:-11.41天)和骨科手术次数减少(方案1:-8.36;方案2:-6.54)。
■Upadacitinib作为1L治疗中重度RA可以大大减少KSA的医疗资源负担,主要是由于减少了药物管理/监测/住院/手术和间接成本。
UNASSIGNED: To evaluate cost-effectiveness of upadacitinib (targeted synthetic-disease modifying anti-rheumatic drug [ts-DMARD]) as first-line (1 L) treatment versus current treatment among patients with rheumatoid arthritis (RA) in the Kingdom of Saudi Arabia (KSA), who had an inadequate response to prior conventional-synthetic (csDMARDs) and/or biologic-DMARDs (bDMARDs).
UNASSIGNED: This Excel-based model included patients with moderate (Disease Activity Score [DAS28]: >3.2 to ≤5.1) or severe RA (DAS28 > 5.1). Cost-effectiveness of current treatment (1 L: adalimumab-originator/biosimilar; second-line (2 L): other bDMARDs/tofacitinib) was compared against a new treatment involving two scenarios (1 L: upadacitinib, 2 L: adalimumab-biosimilar [scenario-1]/adalimumab-originator [scenario-2]) for a 10-year time-horizon from societal perspective. Model outcomes included direct and indirect costs, quality-adjusted life-years (QALYs), hospitalization days, number of orthopedic surgeries, and incremental cost-utility ratio (ICUR) per QALY.
UNASSIGNED: With the current pathway, estimated total societal costs for 100 RA patients over 10-year period were Saudi Riyal (SAR) 50,450,354 (United States dollars [USD] 13,453,428) (moderate RA) and SAR50,013,945 (USD13,337,052) (severe RA). New pathway (scenario-1) showed that in patients with moderate-to-severe RA, upadacitinib led to higher QALY gain (+8.99 and +15.63) at lower societal cost (cost difference: -SAR2,023,522 [-USD539,606] and -SAR3,373,029 [-USD899,474], respectively). Thus, as 1 L, upadacitinib projects \"dominant\" ICUR per QALY over current pathway. Moreover, in alternate pathway (scenario-2), upadacitinib also projects \"dominant\" ICUR per QALY for patient with severe RA (QALY gain: +15.63; cost difference: -SAR 164,536 [-USD43,876]). However, moderate RA was associated with additional cost of SAR1,255,696 (USD334,852) for improved QALY (+8.99) over current pathway (ICUR per QALY: SAR139,742 [USD37,264]). Both scenarios resulted in reduced hospitalization days (scenario-1: -14.83 days; scenario-2: -11.41 days) and number of orthopedic surgeries (scenario-1: -8.36; scenario-2: -6.54) for moderate-to-severe RA over the current treatment pathway.
UNASSIGNED: Upadacitinib as 1 L treatment in moderate-to-severe RA can considerably reduce healthcare resource burden in KSA, majorly due to reduced drug administration/monitoring/hospitalization/surgical and indirect costs.