Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis in adults, affecting approximately 1.5 million Americans. RA is more common in women and may occur at any age, with peak incidence occurring at ages 50-60 years. RA is typically characterized by morning stiffness and symmetrical joint swelling of the feet, hands, and knees, although any joint (and in some cases, internal organs) may be involved. The course of RA may be complicated by cardiac, hematologic, and other extra-articular manifestations.

Despite upadacitinib reaching common thresholds for cost-effectiveness when compared to adalimumab, the independent appraisal committee’s votes on upadacitinib’s long-term economic value were split between “low” and “intermediate” due to concerns about the generalizability of the clinical data to patients in the real world.

During the policy roundtable, experts expressed frustration over the dysfunctional rebate structure that distorts coverage and access to therapies indicated to treat several inflammatory diseases.

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Interventions of Interest:

JAK- Inhibitors

  • Baricitinib (Olumiant®, Eli Lilly and Co.)
  • Tofacitinib (Xeljanz®, Pfizer)
  • Upadacitinib (Rinvoq™, AbbVie)
  • adalimumab (Humira®, AbbVie)

Final Documents

Below you will find the final documents from the policy paper review process:

ICER’s Chief Scientific Officer Pamela Bradt, MD, MPH stated:

“Rheumatoid arthritis is a progressively disabling condition, and patients are fortunate to have multiple therapy options — including biosimilars — that effectively slow disease progression. Many economists might expect medicines to become more affordable in an increasingly crowded therapeutic class; however, because the current rebate structure has erected barriers between patients and several emerging RA therapies, traditional market dynamics have been unable to drive down prices. Therefore, while upadacitinib appears to achieve common thresholds for cost-effectiveness when compared to adalimumab, legitimate questions remain about whether or not adalimumab, launched 17 years ago, is fairly priced to begin with.”