Rituparna Bhattacharya and Khalid M. Kamal
Objective: Tofacitinib is a novel oral biologic that has been approved for treating adults with Rheumatoid arthritis (RA) having inadequate response to or are intolerant of methotrexate (MTX). The objective of this study was to conduct a budget impact model (BIM) analysis for estimating direct annual drug costs for individuals with RA before and after the introduction tofacitinib as a formulary option. Research Design and Methods: The BIM was developed using a US healthcare payer?s perspective with a one-year time frame. The tumor necrosis factor inhibitors (anti-TNFs) adalimumab, etanercept, infliximab, golimumab and certolizumab were considered as comparators. The BIM tested two base-case scenarios: ?Base-case scenario 1: Incident anti-TNF users?; ?Base-case scenario 2: Prevalent anti-TNF users?. Both the scenarios were evaluated under the following two conditions: (1) assuming monotherapy except for infliximab and golimumab and (2) assuming combination therapy with MTX. One way sensitivity analyses were conducted to test the uncertainty in model parameters. Main Outcome Measures: Per member per month cost. Results: Under scenario 1, the decrease in total annual budget for the revised formulary was expected to be $449,769 or $0.04 per member per month (PMPM). With combination therapy, the over-all budget decrease was $43,482 or $0.004 PMPM. For scenario 2, the total annual budget savings with the revised formulary was expected to be $1,536,712 or $ 0.13 PMPM and $ 148,564 or $ 0.012 PMPM for mono and combination therapy, respectively. One-way sensitivity analysis revealed that results were sensitive to adherence rates of anti-TNFs and tofacitinib. Conclusion: Given the easier route of administration and minimal impact on budget of health plans, tofacitinib can be considered as a viable treatment option for individuals with Rheumatoid Arthritis.