Cost-effectiveness analysis of tofacitinib for the treatment of moderate to severe rheumatoid arthritis: a systematic review and meta-analysis

As rheumatoid arthritis (RA) is a chronic and progressive disease that requires lifelong therapeutic intervention, it represents a considerable economic burden on those affected. This study investigated whether tofacitinib is a cost-effective therapeutic alternative to other DMARDs for treating moderate-to-severe RA. All economic evaluation studies of tofacitinib compared to other DMARDs were identified. Using random-effects meta-analysis, we pooled incremental net benefit (INB) in (purchasing power parity) adjusted US$ with 95% confidence intervals. The modified economic evaluation bias checklist and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) instrument for quality appraisal were used. The subgroup analysis was done based on the comparator regimen. Of the selected 11 studies, the number of studies from high-, upper-middle- and lower-middle-income countries was 7, 3, and 1, respectively. The subgroup analysis showed that tofacitinib with an INB of 19,180 US$ [95% CI, −34520 to −3840; p-value = 0.01] was not statistically cost-effective compared with cDMARDs (p-value > 0.0001). Compared to other DMARDs, the estimated pooled INB of tofacitinib was US$ 7260 [95% CI, 3030 to 11,480; p-value < 0.001], but there was substantial heterogeneity among the included studies, and the observed publication bias While tofacitinib shows potential as a cost-effective treatment, tailored economic evaluations are needed to account for the diverse and evolving contexts of RA treatment. PROSPERO: CRD42023405970.

类风湿关节炎（RA）是一种需终身治疗干预的慢性进展性疾病，会给患者带来沉重的经济负担。本研究旨在探讨托法替布相较于其他改善病情抗风湿药（DMARDs），是否可作为中重度RA患者的成本效益治疗替代方案。本研究检索了所有对比托法替布与其他改善病情抗风湿药的经济学评价研究，采用随机效应Meta分析对以购买力平价（PPP）调整的美元计价的增量净收益（INB）进行合并，并给出95%置信区间。研究采用改良版经济学评价偏倚检查表及推荐、评估、制定与评价（GRADE）工具开展质量评价，并基于对照治疗方案开展亚组分析。纳入的11项研究中，分别有7项、3项、1项来自高收入、中高收入及中低收入国家。亚组分析显示，与传统改善病情抗风湿药（cDMARDs）相比，托法替布的INB为19180美元[95%CI：-34520~-3840；P=0.01]，统计学上未体现出成本效益优势（P>0.0001）。与其他改善病情抗风湿药相比，托法替布合并后的INB估计值为7260美元[95%CI：3030~11480；P<0.001]，但纳入研究间存在显著异质性，且存在发表偏倚。尽管托法替布作为成本效益治疗方案具有潜在应用价值，但仍需开展针对性的经济学评价，以适配类风湿关节炎治疗多样化且不断变化的临床情境。本研究方案已在PROSPERO注册：CRD42023405970。