Cost-Utility and Budget Impact Analysis of Tumor Necrosis Factor-Alpha Inhibitors for the Treatment of Refractory Nonsystemic Juvenile Idiopathic Arthritis in Thailand
4
Issued Date
2026-01-01
Resource Type
ISSN
22121099
eISSN
22121102
Scopus ID
2-s2.0-105032564162
Journal Title
Value in Health Regional Issues
Rights Holder(s)
SCOPUS
Bibliographic Citation
Value in Health Regional Issues (2026)
Suggested Citation
Kittiratchakool N., Ekakkararungroj C., Vilaiyuk S., Charuvanij S., Khaosut P., Lerkvaleekul B., Sukharomana M., K.C. S., Kingkaew P. Cost-Utility and Budget Impact Analysis of Tumor Necrosis Factor-Alpha Inhibitors for the Treatment of Refractory Nonsystemic Juvenile Idiopathic Arthritis in Thailand. Value in Health Regional Issues (2026). doi:10.1016/j.vhri.2026.101601 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115762
Title
Cost-Utility and Budget Impact Analysis of Tumor Necrosis Factor-Alpha Inhibitors for the Treatment of Refractory Nonsystemic Juvenile Idiopathic Arthritis in Thailand
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives To evaluate the cost-utility and budget impact of introducing individual tumor necrosis factor-alpha inhibitors, including adalimumab, etanercept, infliximab, and golimumab, as add-on therapies for patients aged 2 years or older with refractory nonsystemic juvenile idiopathic arthritis in Thailand. Methods Decision-tree and Markov models were used to conduct a cost-utility analysis from a societal perspective to estimate lifetime costs and health outcomes. Direct medical and nonmedical costs were obtained from a hospital database and a previous study, respectively. Health-related quality of life (QALY) was measured using the proxy child-friendly EQ-5D and a visual analog scale. Costs and outcomes were discounted at 3% per year. Results are presented as incremental cost-effectiveness ratios (ICERs) in Thai Baht (THB). Sensitivity analyses were conducted to assess parameter uncertainty, and a 5-year budget impact analysis was performed from a governmental perspective. Results Adalimumab demonstrated the lowest ICER (205 012-205 225 THB/QALY), followed by infliximab (441 077-640 657), etanercept (2 134 756-2 280 312), and golimumab (93 198 577). Price reductions of 28% for adalimumab and 43% to 74% for infliximab are required to meet the Thai cost-effectiveness threshold of 160 000 THB/QALY. For the base-case analysis, the 5-year budget impact of infliximab (175-244 million THB) was similar to that of adalimumab (239 million THB), whereas adalimumab achieved greater QALY gains (1.97 vs 0.76). Conclusions Although none of the tumor necrosis factor-alpha inhibitors were cost-effective at the current Thai threshold, adalimumab yielded the most favorable ICER among the evaluated options, whereas infliximab offered a lower budget impact at threshold prices.