Cost-effectiveness analysis of upadacitinib as a treatment option for patients with rheumatoid arthritis in the Kingdom of Saudi Arabia

Abstract

Aim

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).

Methods

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.

Results

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.

Conclusion

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.

Keywords:

• Costs and cost analysis
• cost-effectiveness
• incremental cost utility ratio
• quality-adjusted life-years
• rheumatoid arthritis
• adalimumab-originator/ biosimilar
• biologic disease modifying anti-rheumatic drug
• tofacitinib
• upadacitinib
• kingdom of saudi arabia

JEL CLASSIFICATION CODES:

• I15
• I1
• I
• C52
• C5
• C

Declaration of financial/other relationships

ZA speaker and advisory honoraria from Pfizer, AbbVie, Lilly and Novartis, IA: speaker and advisory honorarium from Pfizer, Lilly, GSK, AbbVie, and Novartis, HAA, SA, WH, BAO have nothing to disclose, YS is full-time employee of IQVIA AG, OM was an employee at IQVIA AG, she has left her position in 2021, MA is a full-time employee at IQVIA Solutions Saudi Arabia, AA, TH and AJ are full-time employees at AbbVie Biopharmaceuticals GmbH and may hold company’s shares.

Author contributions

All authors have contributed to the development of this paper equally.

Acknowledgements

The authors would like to thank all contributors for their commitment and dedication to the goals of RA. The authors would like to acknowledge the writing assistance provided by Prashee Peer, and Saurabh Trikha (IQVIA, India) and statistical analysis support provided by Shruti Patil (IQVIA, India) which was funded by AbbVie. The authors are fully responsible for all content and editorial decisions, were involved at all stages of manuscript development, and have approved the final version.

Data availability statement

The data that support the findings of this study are available from the corresponding author, MA, upon reasonable request.

Previous presentation

Some parts of the study were presented at the Virtual ISPOR conference (ISPOR US May 15-18, 2022).

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The study was funded by AbbVie Ltd, Kingdom of Saudi Arabia. AbbVie contributed to the design, analysis, and interpretation of data; in reviewing and approval of final version based on the authors’ input and direction. No honoraria or payments were made for authorship.