Following the news that ICER has published its latest draft of the evidence report, ‘Janus Kinase Inhibitors for Rheumatoid Arthritis: Effectiveness and Value’;

Rose Joachim, Pharmaceutical Analyst at GlobalData, a leading data and analytics company, offers her view:

“Following the surprise withdrawal of ICER’s initial draft evidence report last month, the organization’s latest draft, published 11 October, sees AbbVie’s Rinvoq (upadacitinib) make a substantial leap in cost-effectiveness. Where once it exceeded even the highest commonly cited thresholds of incremental cost-utility ratios, it now falls below the majority of them.

“This powerful shift in the drug’s cost-benefit profile is due to key changes in the way ICER designed its model. One of the biggest changes was the way in which second and later lines of therapy were modeled following a first-line JAK inhibitor failure. In the document’s previous iteration, the second line of therapy was assumed to be palliative care, which was also taken to have no cost. ICER noted that this did not reflect real-world practice, as patients typically continue to cycle through other treatments following failure of a first line agent and stated this was a major limitation of the initial analysis.

“In the updated model, when patients fail one line of treatment, they now transition to a market basket of targeted immune modulators as second and subsequent lines of therapy. As ICER cautioned that this approach has the potential to overestimate the efficacy of first-line therapies over the lifetime of the model, the organization chose to switch the time horizon of the model from a lifetime to one-year analysis.

“Similar to ICER’s initial draft of the report, Rinvoq was the only therapy that could be directly analyzed for cost-utility ratios, mainly due to a lack of data available for Pfizer’s Xeljanz (tofacitinib) and Eli Lilly’s Olumiant (baricitinib).

“GlobalData estimates that by 2027, the JAK inhibitor class in the US rheumatoid arthritis (RA) market will be worth nearly $1.9bn, about 10% of the total RA market. This figure would be higher save for the projected launch of tofacitinib generics in 2025, which are anticipated to have fairly drastic discounts. However, despite the expected availability of cheap tofacitinib copies within the coming decade, GlobalData still anticipates that by 2027, US sales for Rinvoq in the treatment of RA will reach nearly $750m.

“Along with Rinvoq’s ties to AbbVie’s Humira, ICER’s apparent vote of confidence for the drug may help give the drug a preferred status among US payers and potentially increase access to the drug upon launch. This would certainly help set it apart within a rapidly growing therapy class.”