Economic Benefit from Improvements in Quality of Life with Upadacitinib: Comparisons with Tofacitinib and Methotrexate in Patients with Rheumatoid Arthritis

Abstract

Introduction: To compare the economic benefit of upadacitinib combination therapy versus tofacitinib combination therapy and upadacitinib monotherapy versus methotrexate monotherapy from improvements in health-related quality of life (HRQOL) in patients with rheumatoid arthritis (RA).

Methods: Data were analyzed from two trials of upadacitinib (SELECT-NEXT and SELECT-MONOTHERAPY) and one trial of tofacitinib (ORAL-Standard) that collected HRQOL measurements using the Short Form 36 (SF-36) Health Survey in patients with RA. Direct medical costs per patient per month (PPPM) for patients receiving upadacitinib 15 mg once daily and methotrexate were derived from observed SF-36 Physical (PCS) and Mental Component Summary (MCS) scores in the SELECT trials using a regression algorithm. Direct medical costs PPPM for patients receiving tofacitinib 5 mg twice daily were obtained from a published analysis of SF-36 PCS and MCS scores observed in the ORAL-Standard trial. Short-term (12-14 weeks) and long-term (48 weeks) estimates of direct medical costs PPPM were compared between upadacitinib and tofacitinib and between upadacitinib and methotrexate.

Results: Over 12 weeks, direct medical costs PPPM were $252 lower (95% CI $72, $446) for upadacitinib-treated patients versus tofacitinib-treated patients. Medical costs PPPM at weeks 24 and 48 and cumulative costs over the entire 48-week period (difference $1759; 95% CI $1162, $2449) were significantly lower for upadacitinib than for tofacitinib. Over 14 weeks, direct medical costs PPPM were $399 lower (95% CI $158, $620) for patients treated with upadacitinib monotherapy compared with those treated with methotrexate alone. Direct medical costs at week 48 and cumulative costs over the entire 48-week period (difference $2044; 95% CI $1221, $2846) were significantly lower for upadacitinib monotherapy compared with methotrexate alone.

Conclusion: In the short and long term, upadacitinib combination therapy versus tofacitinib combination therapy and upadacitinib monotherapy versus methotrexate monotherapy were associated with significantly lower direct medical costs for patients with RA.

Trial registration: ClinicalTrials.gov identifier, NCT02675426, NCT02706951, and NCT00853385.

Keywords: Health-related quality of life; Healthcare costs; Methotrexate; Rheumatoid arthritis; Tofacitinib; Upadacitinib.

© 2021. The Author(s).

Figures

Fig. 1

Estimated long-term direct medical costs PPPM with upadacitinib combination therapy versus placebo or tofacitinib combination therapy. Average monthly medical costs for upadacitinib 15 mg QD and placebo were estimated on the basis of SF-36 PCS and MCS scores from SELECT-NEXT using a published algorithm [23] and are adjusted to 2020 US dollars. Costs and standard errors for tofacitinib 5 mg BID were taken from Rendas-Baum et al. [22]. BID twice daily, MCS Mental Component Summary, PCS Physical Component Summary, PPPM per patient per month, QD once daily, SF-36 36-Item Short-Form Health Survey, TOFA tofacitinib, UPA upadacitinib, US United States

Fig. 2

Estimated long-term direct medical costs PPPM with upadacitinib monotherapy versus methotrexate monotherapy. Average monthly medical costs for upadacitinib 15 mg QD monotherapy and methotrexate monotherapy were estimated on the basis of SF-36 PCS and MCS scores from SELECT-MONOTHERAPY using a published algorithm [23] and are adjusted to 2020 US dollars. MCS Mental Component Summary, MTX methotrexate, PCS Physical Component Summary, PPPM per patient per month, QD once daily, SF-36 36-Item Short-Form Health Survey, UPA upadacitinib, US United States.