Comparison of the clinical efficacy and pharmacoeconomics of tofacitinib and adalimumab in Chinese patients with rheumatoid arthritis: An analysis based on propensity score matching.

OBJECTIVE: This study aimed to investigate the clinical efficacy and pharmacoeconomics of tofacitinib versus adalimumab in treating patients with rheumatoid arthritis (RA).

METHODS: Propensity score matching was used to obtain matched cohorts of 116 RA patients treated with tofacitinib or adalimumab. Clinical and laboratory indicators were compared before and after treatment between the two groups. A Markov model was used to assess cost-effectiveness, incorporating direct and indirect costs. Sensitivity analyses validated model stability, with a 6-month cycle simulating lifelong disease progression (27 years).

RESULTS: Both the tofacitinib-treated group and the adalimumab-treated group showed significant improvements in terms of swollen and tender joint counts, duration of morning stiffness, VAS and HAQ scores, and ESR, CRP, and DAS28 levels (P&#x2009;< 0.05). Adalimumab treatment resulted in reductions in rheumatoid factor levels (P&#x2009;< 0.05). ACR20 (&#x3c7;&#x2009;= 0.240, P&#x2009;= 0.624), ACR50 (&#x3c7;&#x2009;= 0.321, P&#x2009;= 0.571), and ACR70 (&#x3c7;&#x2009;= 0.222, P&#x2009;= 0.637) response rates did not differ significantly between groups. Adverse events included tuberculosis, leukopenia, mild liver dysfunction in the adalimumab group, and herpes zoster and mild liver dysfunction in the tofacitinib group, with gastrointestinal reactions observed in both groups (P&#x2009;> 0.05). Cost-effectiveness analysis indicated that tofacitinib was more cost-effective than adalimumab. Univariate sensitivity analysis identified ACR50 and ACR70 response rates as key influencing factors, while probabilistic sensitivity analysis showed a 99.38% probability of tofacitinib being cost-effective relative to adalimumab.

CONCLUSION: Tofacitinib combined with methotrexate demonstrated comparable clinical efficacy and safety to adalimumab combined with methotrexate, with better cost-effectiveness, supporting its use as a favorable treatment strategy. Key Points &#x2022; Our research indicates that tofacitinib exhibits a more favorable pharmacoeconomic profile for treating rheumatoid arthritis, characterized by reduced treatment costs and increased quality-adjusted life years. &#x2022; Tofacitinib consistently demonstrated its cost-effectiveness superiority over adalimumab across various sensitivity analyses, exhibiting a 99.38% likelihood of being more cost-effective.