Transforming rheumatoid arthritis care: dynamic budget impact models with ACR to DAS28 mapping for anti-TNFs, JAK inhibitors, and interleukins.

INTRODUCTION/

OBJECTIVES

Rheumatoid arthritis (RA) is a chronic autoimmune disease with substantial impacts on quality of life and healthcare systems. This study aimed to evaluate how the introduction of biologics and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) for managing moderate to severe RA in the Kingdom of Saudi Arabia (KSA) impacts efficacy, safety, and cost within the treatment pathway.

METHOD: An Excel-based budget impact model was developed to estimate the financial consequences of adopting biologics and tsDMARDs from a payer perspective. It considered the direct treatment costs, cost offsets from reduced complications and hospitalizations, and the effect of managed-entry agreements (MEAs), assessed over 6-month cycles within a 5-year time horizon. Data inputs were derived from published literature, clinical guidelines, and a mapping technique used to correlate treatment efficacy across clinical trials. Sensitivity assessed the influence of varying parameters on the model outcomes.

RESULTS

The introduction of biologics and tsDMARDs at different stages of the treatment pathway led to variable budget impacts ranging from -28% to + 79% from the base case (SAR 1,237 million) for low disease activity (LDA) and - 28% to + 86% from the base case (SAR 1,095 million) for remission as the outcome. Earlier adoption increased initial costs but showed potential for long-term savings. MEAs significantly reduced net costs (- 29% to + 65% for LDA; - 30% to + 71% for remission from the base case), enhancing affordability. These findings support the hypothesis that strategic use of these therapies and agreements influences overall financial outcomes.

CONCLUSIONS

Integrating biologics and tsDMARDs, particularly through MEAs, can optimize RA treatment while managing costs. These results provide valuable insights for healthcare decision-makers in KSA, emphasizing the importance of cost-effective resource allocation. Key Points • A budget impact model was developed for Rheumatoid arthritis (RA) therapies in the Saudi healthcare context. • Managed-entry agreements (MEAs) reduce the net financial burden of newer RA treatments. • Early use of biologics and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) can offer long-term savings despite higher upfront costs.