Budget Impact Analysis of Subcutaneous Infliximab (CT-P13 SC) for Treating Autoimmune Diseases in Jordan

Budget Impact Analysis of Subcutaneous Infliximab (CT-P13 SC) for Treating Autoimmune Diseases in Jordan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Budget Impact Analysis of Subcutaneous Infliximab (CT-P13 SC) for Treating Autoimmune Diseases in Jordan Rimal Mousa, Shiraz Halloush, Farah Radaydeh, Majed S. Al Yami, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8442562/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Autoimmune diseases are increasingly prevalent, and their management in Jordan relies heavily on costly intravenous infliximab (IV IFX). Subcutaneous infliximab (IFX SC) may offer cost savings by reducing administration-related expenses. This study aims to investigate the financial impact of adding IFX SC to the currently available IV IFX, including originator and biosimilars, for the treatment of six autoimmune diseases: rheumatoid arthritis (RA), ulcerative colitis (UC), Crohn's disease (CD), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and psoriasis (PS) in the Jordanian market from a payer perspective. Method A prevalence-based budget impact model was constructed to compare the current treatment environment without IFX SC (base case) with two future scenarios over a 5-year time horizon; 1st scenario: total adoption of IFX SC, 2nd scenario: gradual adoption of IFX SC. The numbers of patients eligible for IFX originator and its biosimilar, in addition to market share adoption, were obtained from official websites. Sensitivity analyses were conducted using Microsoft Excel® to test the robustness of results to any variation of key input parameters, Results Over the 5-year horizon, the largest cost savings were observed in PS, PsA, and AS (–20.6 to − 32.9 million JD; − 29.0 to − 46.4 million USD), while lower savings were seen in RA, UC, and CD (–3.3 to − 5.3 million JD ( − 4.7 to − 7.6 million USD)). Conversion to the more cost-saving scenario enabled expansion of treatment access, with the number of eligible patients increasing over time, particularly in highly prevalent conditions such as PS, PsA, and AS. The highest budget impact per patient was observed in UC and CD (approximately − 8,700 JD (–12,267 USD)), whereas the lowest was in RA (–2,744 JD ( − 3,869 USD)). Conclusions In this study, there is a cost-saving potential with IFX SC use compared to IV IFX. These cost-savings, alongside the benefits of fewer hospital visits, additional eligible patients, and more efficient use of healthcare personnel time, support considerations of IFX SC reimbursement within the Jordanian healthcare system, while real-world evidence is needed to address uncertainties related to comparative effectiveness, patient tolerability and clinical acceptance. Budget Impact Infliximab Autoimmune disease Jordan Biosimilar Figures Figure 1 Figure 2 Introduction Autoimmune diseases (ADs) are a group of autoinflammatory diseases caused by the immune system's antibodies attacking itself. These diseases can affect practically every organ in the body and develop at any level throughout a person's life ( 1 ). The global prevalence of ADs is significantly increasing, partly due to changes in contact with environmental factors. This development carries significant implications for the health-related quality of life of families and patients, as well as impacting health-related expenditures ( 2 ).The estimated prevalence of ADs in the USA is around 5%, while in Europe, it is estimated to be approximately 10% ( 1 , 3 , 4 ). Nevertheless, there is a limited data on the prevalence of ADs in the Middle East, especially in Jordan ( 3 ). Managing these ADs is difficult, requiring a balance between enhancing the quality of life and slowing the progression of the disease ( 2 ). Biologics play a crucial role in suppressing the inflammatory pathways associated with various ADs. In Europe, current approved biological treatments include tumor necrosis factor inhibitors (TNFi) therapies (such as adalimumab, infliximab, and golimumab), anti-integrin agents (like vedolizumab), and anti-IL-12/23 agents (such as ustekinumab)( 5 ). TNF, a monoclonal antibody targeting TNF-alpha, is considered a treatment of choice for various types of ADs, including inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn's disease (CD), rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and psoriasis (PS). The US Food and Drug Administration (FDA) has approved five TNF inhibitors—adalimumab, infliximab, etanercept, golimumab, and certolizumab—for diverse indications. These drugs can be prescribed alone or in conjunction with other agents such as methotrexate, Prednisone, sulfasalazine, leflunomide, and hydroxychloroquine ( 5 ). Intravenous infliximab (IFX, Remicade) was the first TNFi approved for RA and IBD ( 6 , 7 ). It currently stands as one of the most prescribed treatments for these conditions. Although they are innovative and effective, biologics such as IFX tend to be more expensive than traditional treatments, thereby limiting their usage. Therefore, the availability of low-cost biosimilars has increased access to these highly effective medications. The European Commission for Medicines Agency (EMA) and the US FDA have approved CT-P13 as the first intravenous IFX biosimilar for the treatment of IBD and RA in 2013 and 2016 ( 8 – 10 ), respectively, followed by the approval of the first IFX subcutaneous (SC) formulation, CT-P13 SC in Europe, for the same indications as the reference IFX and its IV biosimilar in 2019 ( 11 ). The presence of CT-P13 SC could be a potential cost saving from the health care provider perspective partly due to reducing outpatient visits and the costs associated with intravenous (IV) administration in addition to the noninferiority results in term of efficacy and safety that was proved as compared to the IV form of CT-P13 in several Phase I/III randomized clinical trials recruited patients with active UC, CD ( 12 ) and severe RA ( 13 ), respectively. Jordan was classified recently as an upper-middle-income country according to the World Bank classification in 2022–2023, with a Gross Domestic Product (GDP) per capita of 4,311 US dollars in 2022 ( 14 ), of which 7.98% of its GDP is dedicated to health care expenditure as compared to 5.63% of GDP in other upper-middle-income countries ( 15 ). Pharmaceuticals contributed to 23.13% of Jordan’s total health expenditures in 2017, according to the Jordan National Health Account (NHA), with a significant part of the expenditures spent on biologics ( 15 ). As a developing country in the Middle East and North Africa (MENA) region, Jordan faces challenges in utilizing the costly biological medications because of their high costs due to the high out-of-pocket costs or premiums the patients should pay out to health insurance companies to cover their health care costs, and therefore, biosimilars provide a great cost-saving potential ( 16 ). Jordan had a high rate of biosimilar approval share versus originators, which is comparable to other high-income countries in the Middle East, such as KSA, UAE ( 17 ). The first IFX IV biosimilar was approved in 2014 by the Jordan Food and Drug Administration (JFDA), permitted (manufacturer: Celltrion, marketing authorization holder: Hikma Pharmaceuticals LLC) ( 18 , 19 ). IFX SC has the potential to significantly reduce the health care administration costs related to staff time and consumables, as compared to IV IFX, in addition to improving work productivity for patients by minimizing the time spent in clinic visits ( 20 ). Therefore, it is useful to quantify the potential cost savings associated with the introduction of SC option. A UK budget impact analysis of IFX SC for RA showed significant cost reductions ( 21 ). Moreover, Unexpected cost savings were seen in four of the big-5 European countries—the UK, Germany, France, and Italy—but not in Spain, according to a budget impact assessment of using IFX SC for the treatment of IBD over a 5-year time horizon ( 22 ). Given the economic burden of biologics, country-specific budget impact analyses are important to inform payer and formulary decisions. Accordingly, this study aims to evaluate the budgetary impact of introducing IFX SC in Jordan compared with IV IFX (both originator Remicade and biosimilar Remsima) for six indications: RA, UC, CD, AS, PsA, and PS, from the public payer perspective. Method Model structure A prevalence-based budget impact model (BIM) was constructed to investigate the financial impact of adding IFX SC to the currently available IV IFX (including originator and biosimilars) for treatment of RA, UC, CD, AS, PsA, and PS as per indication in the Jordanian market from a payer perspective. Two scenarios were performed and compared to the base case analysis as follows Base case analysis: Current treatment environment, including World without biosimilar IFX SC (i.e., only the presence of IFX originators and their IV biosimilars) 1st scenario: World with total adoption of Future treatment environment, i.e. total adoption of IFX’s biosimilar instead of the current treatment environment (i.e., IFX originators and their IV biosimilars) 2nd scenario: World with gradual adoption of IFX SC Future treatment environment, i.e. IFX’s biosimilar is added to the current treatment environment based on the Jordanian Market share derived from the Government Procurement Department (GPD). Time horizon The scenario was developed for a 5-year horizon. The time horizon chosen is sufficient to observe the impacts of SC infliximab’s biosimilar implementation on the health care budget over the next year following the uptake, since the share of the biosimilar is expected to increase over the upcoming years in the public sector. Model Assumptions Dosing information and treatment assumptions The dosing information indicated to treat adult patients with TNFi for each indication was obtained from the summary of product characteristics (SmPC) Average patients’ weights used to estimate the total dose regimen for each indication were consistent with previous literature ( 23 – 26 ). Drugs’ vials were assumed not to be considered for vial sharing, and no wastage is considered for the same patient. All patients were assumed to receive an induction of an IV loading dose of infliximab six weeks ahead, followed by maintenance schedules in the subsequent years. This is to reflect the clinical trial phase III protocol and the most common practices on IFX SC and IV available in the literature ( 27 ). Moreover, SC IFX was assumed to be non-inferior to IV in terms of efficacy and safety based on comparable results in phase I and III double-blinded randomized trials ( 28 ). Dose escalation rates for IFX were adopted as reported by the published systematic reviews and meta-analysis by Savelkoul 2022 and Qiu 2017 for adult patients with UC and CD ( 29 , 30 ). Number of patients eligible for biological treatments The number of patients eligible for infliximab treatment was calculated by multiplying the number of the Jordanian population (11.4 million) ( 31 ) by the prevalence rate of each AD (Table 1 ) ( 32 ) and the proportion of patients eligible to receive the infliximab regimen for each AD. The Jordanian population data were extracted from the Office for National Statistics (ONS) databases ( 31 ), and the prevalence rate was obtained from the Institute for Health Metrics and Evaluation (IHME) databases ( 32 ). The latter percentage was obtained by multiplying the proportion of patients eligible for bDMARDs by the market share of infliximab among bDMARDs, obtained from the Jordanian GPD (29%) (Table 1 ) for patients with RA, PsA, AS. For patients with UC and CD, patients were eligible if they had moderately or severely active CD or UC with an inadequate response to conventional therapy (including corticosteroids, 6-mercaptopurine, or azathioprine) who were intolerant to or had medical contraindications for these therapies. Details used to calculate the eligibility rate for CD and UC are provided in Supplementary Table 1. To account for the new patients diagnosed with each AD over the forthcoming 5 years, the annual prevalence data were adjusted by incorporating a projected yearly incidence rate. These projections were based on population trends and provide a foundation for estimating based on the prevalence data from the past five years obtained from the IHME, form the basis for estimating the projected prevalence of the six target indications evaluated in this study, as presented in Table 2 . Table 1 The number of patients eligible to receive the infliximab regimen for each Autoimmune disease Indication Calculations Indication criterion 11,400,000.00 Population inJordan Jordan Population 2024 (Live) (worldpopulationreview.com) The number of patients eligible for bDMARDs Rheumatoid arthritis 14,387.32 Prevalence of RA IHME data2024 36.80% Percentage of patients eligible for Biological DMARD (With severe, active and progressive disease and unresponsive to conventional DMARD Assumed it is the same as the consumption of BDMARD among Jordanian patients diagnosed with RA https://doi.org/10.29333/ejgm/13521 25.70% Adult patients not previously treated with methotrexate or other DMARDs Olsen IC, Lie E, Vasilescu R, Wallenstein G, Strengholt S, Kvien TK. Assessments of the unmet need in the management of patients with rheumatoid arthritis: analyses from the NOR-DMARD registry. Rheumatology. 2018;58( 3 ):481 − 91. 21.36% With severe, active and progressive disease Carpenter L, Nikiphorou E, Norton S, Jayakumar K, Dixey J, Young A. Patients with moderate disease activity in the first 5 years of rheumatoid arthritis still progress radiographically despite conventional disease modifying therapy.: 2135. Arthritis & Rheumatology. 2014;66. 42.29% Sum of patients eligible for biological DMARD 29.03% Patient share of infliximab among bDMARDs Joint procurement department 12.28% All patients with RA require infliximab 1,766.28 Total with RA IBD 5,740.15 Prevalence of IBD IHME data2024 Ulcerative colitis 67.00% Among IBD https://pubmed.ncbi.nlm.nih.gov/34227982/ 22.00% Moderately to severely active ulcerative colitis The facts about inflammatory bowel diseases: https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127456/ 52.00% Adult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-MP) or azathioprine (AZA), or who are intolerant to or have medical contraindications for such therapies Assumed the same as in Crohn's disease. The Cochrane Library 2016. Azathioprine or 6-mercaptopurine for induction of remissionin Crohn’s disease (Review): https://www.cochranelibrary.com/cdsr/doi/ 10.1002/14651858.CD000545.pub5/epdf/standard is stated that: "There was no statistically significant difference in clinical remission rates between azathioprine or 6-mercaptopurine and placebo. Forty-eight per cent (95/197) of patients receiving antimetabolites achieved remission compared to 37% (68/183) of placebo patients (5 studies,380 patients; RR 1.23, 95% CI 0.97 to 1.55)". 11.44% of all people with UC 439.97 Total number Crohn's disease 33.00% Among IBD https://pubmed.ncbi.nlm.nih.gov/34227982/ 23.01% Moderately to severely active Crohn's disease Cosnes 2012 (France): https://gut.bmj.com/content/gutjnl/61/8/1140.full.pdf Source data: people with severe CD (321/600) with active disease (median 43%) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127456/ 52.00% Adult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-MP) or azathioprine (AZA), or who are intolerant to or have medical contraindications for such therapies The Cochrane Library 2016. Azathioprine or 6-mercaptopurine for induction of remissionin Crohn’s disease (Review): https://www.cochranelibrary.com/cdsr/doi/ 10.1002/14651858.CD000545.pub5/epdf/standard is stated that: "There was no statistically significant difference in clinical remission rates between azathioprine or 6-mercaptopurine and placebo. Forty-eight per cent (95/197) of patients receiving antimetabolites achieved remission compared to 37% (68/183) of placebo patients (5 studies,380 patients; RR 1.23, 95% CI 0.97 to 1.55)". 11.96% Sub total 35.00% Fistulising, active Crohn's disease Gecse 2013 (US): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040755/ 52.00% Adult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-MP) or azathioprine (AZA), or who are intolerant to or have medical contraindications for such therapies The Cochrane Library 2016. Azathioprine or 6-mercaptopurine for induction of remissionin Crohn’s disease (Review): https://www.cochranelibrary.com/cdsr/doi/ 10.1002/14651858.CD000545.pub5/epdf/standard is stated that: "There was no statistically significant difference in clinical remission rates between azathioprine or 6-mercaptopurine and placebo. Forty-eight per cent (95/197) of patients receiving antimetabolites achieved remission compared to 37% (68/183) of placebo patients (5 studies,380 patients; RR 1.23, 95% CI 0.97 to 1.55)". 18.20% Sub total 18.20% of all people with CD Because the two groups overlap to a certain extent, the largest value was considered. 344.75 Total number of CD AS 71,936.59 Prevalence of AS https://www.ncbi.nlm.nih.gov/books/NBK532288/ 54.00% Severe, active ankylosing spondylitis (BASDAI ≥ 40) NICE technology appraisal 383, 2014: https://www.nice.org.uk/guidance/ta383/chapter/4-Committee-discussion 40.00% Patients who responded inadequately to conventional therapy (NSAIDs) Baraliakos 2017 (Germany): https://academic.oup.com/rheumatology/article/56/1/95/2444589 29.00% Patient share of infliximab among bDMARDs Government Procurement Department 21.60% of all people with AS 4,506.11 Total number of AS Psoriatic arthritis 69,225.58 Prevalence of Psoriasis IHME data2024 30.00% Percentage of psoriatic patients with psoriatic arithritis https://doi.org/10.1007/s00296-019-04319-3 78.00% Active and progressive psoriatic arthritis Disease Activity index for Psoriatic arthritis scores for 2017 from: https://arthritis-research.biomedcentral.com/articles/ 10.1186/s13075-018-1659-z/figures/1 62.39% in adult patients when the response to previous DMARD therapy has been inadequate Wilsdon 2011 (Australia): https://www.ncbi.nlm.nih.gov/pubmed/30656673 Source data: Methotrexate reponse rate 41/109 29.00% Patient share of infliximab among bDMARDs Government Procurement Department 48.66% of all people with PsA 2,930.64 Total number with PsA Psoriasis 69,249.89 Psoriasis in jordan IHME data2024 25.00% Moderate to severe plaque psoriasis Colombo 2013: https://www.hindawi.com/journals/tswj/2013/805705/ 54.80% Adult patients who failed to respond to, or who have a contraindication to, or are intolerant to other systemic therapy including cyclosporine, methotrexate or psoralen ultra-violet A West 2016: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864230/ MTX response 45.2% 29.00% Patient share of infliximab among biologicals Government Procurement Department Table 2 The projected annual number of cases diagnosed (prevalence number) with the six ADs over the 5-year period a Prevalence (number) (mean (95%CI)) UC Crohn's AS RA PsA Psoriasis 2024 439.97 (437.81,442.13) 344.75 (343.06,346.44) 1766.28 (1760.75,1771.81) 4491.99 (1771.81,4506.11) 2750.33 (2749.37,2751.3) 2929.61 (2751.3,2930.64) 2025 460.67 (458.37,462.98) 360.97 (359.17,362.78) 1851.33 (1845.42,1857.24) 4708.02 (1857.24,4723.09) 2865.21 (2864.18,2866.24) 3051.95 (2866.24,3053.05) 2026 481.37 (478.86,483.89) 377.20 (375.23,379.17) 1936.38 (1929.94,1942.83) 4923.62 (1942.83,4940.08) 2980.09 (2978.96,2981.21) 3174.26 (2981.21,3175.46) 2027 502.08 (499.29,504.87) 393.42 (391.23,395.6) 2021.44 (2014.28,2028.59) 5138.81 (2028.59,5157.06) 3094.96 (3093.71,3096.21) 3296.54 (3096.21,3297.87) 2028 522.78 (519.65,525.9) 409.64 (407.19,412.09) 2106.49 (2098.47,2114.51) 5353.59 (2114.51,5374.04) 3209.84 (3208.44,3211.24) 3418.78 (3211.24,3420.27) a Note: AD : Autoimmune Disease, UC : Ulcerative Colitis; RA : Rheumatoid Arthritis; AS : Ankylosing Spondylitis; PsA : Psoriatic Arthritis Prevalence of each disease estimated as the total number of cases in the Jordanian population Market share for biological treatments The market share for the infliximab’s biosimilars and its originator for both worlds with/out Remsima SC was calculated in consistent with the consumption observed in GPD, which was used to calculate the patients' share of infliximab’s biosimilar and its comparators. The model computed the market share of the following biologics, including Infliximab’s biosimilars (Remsima SC and Remicade), and Remsima (Originator). The share of Remsima SC was taken from the Remsima IV and Remicade IV. This share assumption was based on the previous GPD data over the last 5 years and experts' opinions as well. The GPD data reflect the total consumption of each biological that is distributed to the public sectors, including the Royal Medical Service, the Ministry of Health, and Jordan University Hospital. For example, the 10% share of Remsima SC was taken from Remsima IV (0.095) and Remicade IV (0.005), increasing up to 50% in Year 5. Table 3 shows the market share for the Infliximab formulations available in Jordan over the 5-year time horizon. Table 3 The market share for the Infliximab formulations available in Jordan over the 5-year time horizon Infliximab formulations Market share (%) Base case scenario (without) Scenario with Year 1 Year 2 Year 3 Year 4 Year 5 Infliximab SC 0 0.1 0.2 0.30 0.40 0.50 Infliximab IV (Remicade) 0.5 0.45 0.4 0.35 0.30 0.25 Infliximab IV (Remsima) 0.5 0.45 0.4 0.35 0.30 0.25 Disease-related costs The study was conducted from Health care payer perspective. The model estimated the direct medical cost including drug acquisition cost in addition to the administration costs of the services associated with the route of administration including (staff time, associated usage of local anesthesia), the costs were obtained from tendering price, which reflects of GDP data the real life managed entry agreement financial mechanisms that were endorsed by the GDP department for the public sector. A 4.75% discount rate to future costs was also applied to reflect the costs and benefits accruing over the 5-year time horizon from 2024 to 2028, based on the Jordanian central bank ( 33 ) . Annual drug costs were estimated by multiplying the number of doses per year by the number of units per dose by the average costs per unit. Average costs per unit had been calculated by multiplying the mg per unit by the price per mg. The total annual costs for the Initial year are different from the maintenance years, reflecting higher dose requirements in the first year of treatment. The costs were reported in 2024 Jordanian Dinar (JD). An exchange rate of 1 JD = 1.41 USD (December 2025) was used. Total budget impact The net budget impact and savings of adopting IFX SC into the Jordanian market were calculated by subtracting the total cost of the “world without” from the “world with” scenarios. In the base-case analysis, the drug acquisition and administration costs were used to estimate the total costs for each comparator in each scenario and then were multiplied by the number of patients and weighted by their market share. The following equation was used to compute the annual savings: Annual Budget Impact = annual associated treatment cost using future environment - annual associated treatment cost using current environment Additional potential patients to expand access to the newer treatment were calculated each year by dividing the annual budget savings by the total costs associated with Remsima SC each year, per each AD. Additional potential patients = (Annual budget Savings of the switching from Remsima IV or Remicade to Remsima SC) ÷ (treatment cost associated with Remsima SC) Sensitivity analysis Deterministic sensitivity analyses were conducted to test the robustness of base case results to any variation of key input parameters, such as the estimates of each disease prevalence around their ranges, discount rates, and price erosion. These were presented as a tornado diagram showing the impact of changing key parameters in the budget impact model. The sensitivity analyses were conducted using Microsoft Excel®. Results Base Case The base case analysis estimated the budget impact of adopting CT-P13 SC over 5-year time horizon in six indications of ADs in Jordan. Table 4 summarizes the net budget, budget impact of introducing IFX SC, and potential additional patients across different indications in ADs Table 4 Total budget impact and number of additional patients following the adoption of IFX SC across six ADs in Jordan a AD Year Year 1 Year 2 Year 3 Year 4 Year 5 Total UC Total net budget 5,005.24 3,185.01 3,157.61 3,130.20 3,102.80 17,580.87 Budget Impact per patient (JD) -250.63 -2,070.86 -2,098.26 -2,125.66 -2,153.07 -8,698.48 Prevalence Budget Impact (JD) -110,268.96 -953,988.96 -1,010,049.61 -1,067,244.78 -1,125,574.48 -4,267,126.80 Number of additional patients 40 322 341 360 380 1,442 Crohn’s Total net budget 5,013.76 3,337.89 3,291.38 2,990.41 2,986.31 17,619.76 Budget Impact per patient (JD) -251.57 -1,927.45 -1,973.96 -2,274.92 -2,279.03 -8,706.93 Prevalence Budget Impact (JD) -86,731.19 -695,759.34 -744,569.45 -894,995.29 -933,578.58 -3,355,633.86 Number of additional patients 32 235 251 302 315 1,133.75 RA Total net budget 3,132.64 2,392.35 2,464.03 2,535.71 2,607.39 13,132.12 Budget Impact per patient (JD) -42.56 -782.86 -711.18 -639.50 -567.82 -2,743.91 Prevalence Budget Impact (JD) -75,175.27 -1,449,331.92 -1,377,114.14 -1,292,703.15 -1,196,098.94 -5,390,423.42 Number of additional patients 27 489 464 436 403 1,820 Psoriasis Total net budget 5,002.00 3,571.57 3,495.85 3,420.13 3,344.41 18,833.97 Budget Impact per patient (JD) -250.27 -1,680.70 -1,756.42 -1,832.14 -1,907.86 -7,427.39 Prevalence Budget Impact (JD) -688,319.95 -4,815,548.21 -5,234,280.65 -5,670,410.58 -6,123,938.01 -22,532,497.41 Number of additional patients 250 1,624 1,765 1,912 2,065 7,616 PsA Total net budget 5,002.00 3,718.95 3,716.91 3,714.88 3,712.84 19,865.58 Budget Impact per patient (JD) -250.27 -1,533.32 -1,535.36 -1,537.39 -1,539.43 -6,395.78 Prevalence Budget Impact (JD) -733,445.87 -4,681,313.66 -4,875,468.71 -5,070,122.15 -5,265,273.97 -20,625,624.35 Number of additional patients 267 1,578 1,644 1,710 1,775 6,974 AS Total net budget 4,528.19 2,969.02 2,968.62 2,968.21 2,967.81 16,401.86 Budget Impact per patient (JD) -73.45 -1,632.63 -1,633.03 -1,633.43 -1,633.84 -6,606.38 Prevalence Budget Impact (JD) -330,987.78 -7,711,051.32 -8,067,297.72 -8,069,290.27 -8,780,315.64 -32,958,942.74 Number of additional patients 86 2,600 2,720 2,721 2,961 11,087 a Note: AD : Autoimmune Diseases; UC : Ulcerative Colitis; RA : Rheumatoid Arthritis; AS : Ankylosing Spondylitis; PsA : Psoriatic Arthritis Overall, the total net budget in the world with SC Remsima was lower than that in the world without SC Remsima. In both the “world with” and “world without” scenarios. This reduction was justified largely due to administration cost savings. The slightly higher drug acquisition cost of the SC formulation was offset by its lower administration as compared to that of the IV formulation. The prevalence budget impact is shown in Table 4 . The lowest budget impact was noticed in year 1, due to the lowest market share, with more cost savings being noticed over the consecutive years, likely due to the increasing market uptake rate. The largest cost-savings over the 5-year period were seen among Psoriasis, PsA and AS, ranging from nearly – 20.6 million JD to – 32.9 million JD (equivalent to – 29 million USD to – 46.4 million USD), while the lowest numbers were see in RA, UC and Crohn’s disease, ranging from nearly – 3.3 million JD to – 5.3 million JD (equivalent to – 4.7 million USD to – 7.6 million USD). For example, over 5 years a total of − 4,267,126.80 JD (–6,016,648.79 USD) was saved among patients with UC, ranging from − 110,268.96 JD (–155,479.23 USD) in year 1 to − 1,125,574.48 JD (–1,587,060.02 USD) in year 5. Figure 1 illustrates the budget impact of introducing Remsima SC in the market over 5 years in six indications. The budget impact analysis conducted over five years reveals compelling insights into the economic implications of the adoption of SC Remsima for treating the six indications in Jordan. The introduction of infliximab biosimilar SC alongside other infliximab formulations demonstrates substantial cost savings, emphasizing the potential for healthcare systems to allocate resources more effectively. Additionally, while SC Remsima exhibits a slightly higher cost compared to the biosimilar, it still contributes noteworthy savings, primarily attributable to its reduced administration costs. This highlights CT-P13 SC as a viable treatment option, especially for patients who may benefit from its specific formulation. The cost per patient for each indication is detailed in Table 4 , showcasing the financial implications associated with each treatment option and underscoring the importance of making informed decisions to enhance patient care while managing healthcare expenditures efficiently. Moreover, the number of additional patients eligible for expanding treatment access that results from conversion to the more cost-saving budget is illustrated in Table 4 . Overall, the number of potential patients increased over the subsequent years. For example, for patients with RA, the number increased from 27 in year 1 to 403 in year 5. The number of patients is dramatically increasing in highly prevalent diseases such as psoriasis, PsA, and AS. The number of patients with Psoriasis increased from 250 in year 1 to 2,065 in year 5. The highest budget impact per patient was seen in IBD, approximately – 8,700 JD (– 12,267 USD) in both UC and Crohn’s disease), while the lowest impact per patient of – 2,744 JD (– 3,869 USD) was seen in RA. One‑Way Sensitivity Analysis The results of the one-way sensitivity analysis are presented in Figure. 2. The variables are shown in decreasing order. Overall, the net budget impact of IFX SC was insensitive to any change of key parameters over their plausible ranges across the six indications, reflecting the robustness of the base case results. In the base case, the key parameters with the biggest impact over 5-year budget savings were the price erosion of IFX SC, followed by the discount rate, and prevalence of ADs (Figure. 2). For example, changing the price erosion for the IFX SC between (45% to 78%) results in a budget saving from − 26,478.07 JD to -1,298,894.00 JD in patients with Crohn’s disease. Discussion To the best of our knowledge, this is the first budget impact analysis addressing the use of subcutaneous Infliximab (CT-P13 SC) for treating autoimmune diseases in Jordan. Our results show that using IFX SC for six autoimmune diseases leads to substantial savings over five years. These savings are mainly driven by the lower administration costs of IFX SC compared to IV IFX. The prevalence of budget impact was the lowest for the six diseases during the first year due to the lowest market share. The utilization of IFX SC in AS, Psoriasis and PsA showed the largest cost savings over a five-year period: – 32.9 million JD, – 22.5 million JD and – 20.6 million JD, respectively. On the other hand, the cost savings for RA, UC, and Crohn's disease were – 5.3 million JD, – 4.2 million JD and – 3.3 million JD, respectively. The sensitivity analysis shows that our results are consistent regardless of any change to key parameters. Moreover, given that the number of additional patients increased over time, these findings underscore the significant economic impact of SC infliximab and the potential for expanding its utilization in Jordan across several autoimmune diseases. The results of this analysis are aligned with the findings from previous studies. A study from Saudi Arabia showed cost savings with the use of IFX SC in patients with UC and Crohn's disease reaching up to -31.9 million Saudi Riyal (SAR) in UC and − 106.2 million SAR in CD at 100% uptake (full adoption) over a two-year period (2021–2023) based on an exchange rate of 1 JD = 5.29 SAR (December 2025) ( 34 ). In addition, two studies, one conducted in the UK and one in Greece, reported cost savings of around £69 million and €2 million in patients with RA and ADs respectively (1 JD = £1.06 = €1.21, December 2025) ( 21 , 35 ). These findings show that reduced administration-related expenditures of IFX SC, regardless of the contrary economic status, will result in significant cost savings. Form healthcare providers perspective, switching from IV to SC infliximab in patients with IBD has shown a reduction in hospital visits, and time previously spent by nurses or technicians on IV infusions can be reallocated to other patients or services, optimizing resource utilization and potentially improving overall health care service delivery. In addition to the possibility of infliximab SC being self-administered at home due to the convenience of administering Infliximab SC, which may improve patients experience and satisfaction as well as their adherence to therapy and quality of life. Furthermore, a five-year budget impact analysis of IFX SC for IBD (CD and UC) was conducted in five European countries (Germany, France, Italy, Spain, and the UK), revealing substantial cost savings, except in Spain, for CD, introducing IFX SC over a 5-year period resulted in cost savings of €42.0 million (UK), €59.4 million (Germany), and €46.4 million (France and Italy). In UC, 5-year saving were €42.7 million (UK), €44.9 million (Germany), €44.3 million (France), and €53.0 million (Italy) ( 36 ). In regards to Spain, modest savings were achieved in the first year followed by a rise in costs from year 2–5, this can be attributed to a combination of pricing strategies and dosing practices, as CT-P13 SC was priced much higher than IV IFX, which ,alongside the progressive market uptake of IFX SC in years 2–5, led to a slight increase in budget expenditure for CD and no savings for UC ( 36 ). Similarly, a three-year budget impact analysis conducted in France ( 37 ) also concluded to a potential increase in costs upon replacing IV infliximab with SC, which is primarily a result of the higher acquisition cost of fixed-dose SC formulation relative to standard 5mg/kg IV dosing used in the study population. However, the sensitivity analysis showed a potential cost saving for patients using more than the standard dosage (IV dose escalation) or with a different pricing condition ( 37 ). Taken together, the findings of our analysis are broadly consistent with the growing body of international evidence evaluation the economic impact of IFX SC across diverse healthcare systems. Studies have uniformly demonstrated that IFX SC generates worthy cost savings when administration costs are substantial or when dose escalation is common ( 21 , 35 , 36 ). Even in settings such as Spain or France where IFX SC was associated with increased expenditures under base-case assumptions, sensitivity analysis showed that pricing strategies and market uptake dynamics can shift outcome towards cost savings ( 36 , 37 ). This is the first budget impact analysis to address the use of IFX SC versus IV IFX in Jordanian patients with autoimmune diseases from a payer perspective. However, our analysis has some limitations worth addressing. The model structure incorporates direct costs, for example, drug acquisition and drug administration, and indirect costs from tendering price, which might affect our cost savings results. In addition, the market share for the evaluated biological treatments was obtained from the historical data in the GDP from Jordan and experts' opinions, which also directly affects our findings. Conclusion This study demonstrates that adoption of IFX SC has the potential to generate meaningful cost savings for the Jordanian healthcare payer regarding these six autoimmune diseases. The most significant savings per patient were mainly in UC and CD compared to other indications. These savings are primarily due to reductions in administration-related expenditures, while offering potential benefits in terms of patient convenience, reduced hospital visits and more efficient use of healthcare personnel time. From a decision-making perspective these findings support considering IFX SC for reimbursement within the Jordanian healthcare system as it may help use healthcare resources more efficiently without increasing overall costs. Nevertheless, the results should be interpreted cautiously given the assumptions and data limitations of the model. Future studies are needed to address the uncertainties surrounding the convenience of administration, patient tolerability, physician acceptance to prescribe SC formulation of infliximab, and the real-world comparative effectiveness of IFX SC versus other tumor necrosis factor (TNF) inhibitors. Abbreviations ADs, autoimmune diseases; AS, ankylosing spondylitis; bDMARDs, biologic disease-modifying antirheumatic drugs; BIM, budget impact model; CD, Crohn’s disease; EMA, European Medicines Agency; FDA, Food and Drug Administration; GDP, gross domestic product; GPD, Government Procurement Department; IBD, inflammatory bowel disease; IFX, infliximab; IHME, Institute for Health Metrics and Evaluation; IV, intravenous; JD, Jordanian dinar; JFDA, Jordan Food and Drug Administration; MENA, Middle East and North Africa; NHA, National Health Account; PS, psoriasis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SAR, Saudi riyal; SC, subcutaneous; SmPC, summary of product characteristics; TNFi, tumor necrosis factor inhibitors; UC, ulcerative colitis; USD, United States dollar. Declarations Compliance with Ethical Standards Ethical approval to obtain the information needed to conduct this study was obtained from the Institutional Review Board of the Jordanian Ministry of Health research committee in accordance with the Declaration of Helsinki. No information was collected directly from patients and thus, consent forms were not collected on the patient level. Consent for publication Not applicable. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution R.M. carried out the study conception, design, data collection, analysis, budget impact modeling, and manuscript drafting. N.K helped in the study conception, design, data collection and modelling. B.B., S.M., A.K., F.R., M.Y. and S.H. contributed exclusively to the critical review and revision of the manuscript. All authors read and approved the final manuscript. Acknowledgement Ongoing Research Funding Program (ORF-2025-76), King Saud University, Riyadh, Saudi Arabia. Data Availability All data generated or analysed during this study are included in this published article. Additional supplementary data will be available upon request from the corresponding author. References Fairweather D, Frisancho-Kiss S, Rose NR. Sex differences in autoimmune disease from a pathological perspective. Am J Pathol. 2008;173(3):600–9. Miller FW. The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment, and prevention. Curr Opin Immunol. 2023;80:102266. Conrad N, Misra S, Verbakel JY, Verbeke G, Molenberghs G, Taylor PN, et al. Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK. Lancet. 2023;401(10391):1878–90. National Academies of Sciences E, and Medicine, Enhancing. NIH Research On Autoimmune Disease [Internet]. 2022. Available from: https://nap.nationalacademies.org/catalog/26554/enhancing-nih-research-on-autoimmune-disease American College of Rheumatology. Tumor Necrosis Factor (TNF) Inhibitors [Internet]. 2025. Available from: https://rheumatology.org/patients/tumor-necrosis-factor-tnf-inhibitors Parigi TL, D'Amico F, Peyrin-Biroulet L, Danese S. Evolution of infliximab biosimilar in inflammatory bowel disease: from intravenous to subcutaneous CT-P13. Expert Opin Biol Ther. 2021;21(1):37–46. D'Haens GR, van Deventer S. 25 years of anti-TNF treatment for inflammatory bowel disease: lessons from the past and a look to the future. Gut. 2021;70(7):1396–405. US Food and Drug Administration. Inflectra: prescribing information [Internet]. 2016. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/125544s000lbl.pdf European Medicines Agency. Inflectra: summary of opinion (initial authorisation) [Internet]. 2013. Available from: https://www.ema.europa.eu/en/documents/smop-initial/chmp-summary-positive-opinion-inflectra_en.pdf European Medicines Agency. Remsima: summary of opinion (initial authorisation) [Internet]. 2013. Available from: https://www.ema.europa.eu/en/documents/smop-initial/chmp-summary-positive-opinion-remsima_en.pdf European Medicines Agency. Remsima: summary of opinion (post authorisation) [Internet]. 2020. Available from: https://www.ema.europa.eu/en/documents/smop/chmp-post-authorisation-summary-positive-opinion-remsima-ii/82_en.pdf Schreiber S, Ben-Horin S, Leszczyszyn J, Dudkowiak R, Lahat A, Gawdis-Wojnarska B, et al. Randomized Controlled Trial: Subcutaneous vs Intravenous Infliximab CT-P13 Maintenance in Inflammatory Bowel Disease. Gastroenterology. 2021;160(7):2340–53. Westhovens R, Wiland P, Zawadzki M, Ivanova D, Kasay AB, El-Khouri EC, et al. Efficacy, pharmacokinetics and safety of subcutaneous versus intravenous CT-P13 in rheumatoid arthritis: a randomized phase I/III trial. Rheumatology (Oxford). 2021;60(5):2277–87. World Bank. World Bank country classifications by income level for 2024–2025 [Internet]. 2024. Available from: http://www.worldbank.org/en/country/jordan/overview Jordan High Health Council. Jordan National Health Accounts for 2016–2017 Fiscal Years Technical Report No. 8 [Internet]. 2019. Available from: https://jordankmportal.com/resources/jordan-national-health-accounts-for-2016-2017-fiscal-years Dargham SR, Zahirovic S, Hammoudeh M, Al Emadi S, Masri BK, Halabi H, et al. Correction: Epidemiology and treatment patterns of rheumatoid arthritis in a large cohort of Arab patients. PLoS ONE. 2019;14(3):e0214258. Alkhatib NS, Halloush S, Abraham I. The status and preparation for the next decade of biosimilars in the Middle Eastern and North African region. Expert Opin Biol Ther. 2023;23(8):671–7. Alawneh K, Al-Mistarehi AH, Qandeel A, Jaber R, Alomari S, Kheirallah KA. The Safety and Effectiveness of Infliximab Biosimilar in Managing Rheumatoid Arthritis: A Real-Life Experience from Jordan. Int J Clin Pract. 2022;2022:3406783. Haqaish WSA, Obeidat H, Patel P, Walker S. The Jordan Food and Drug Administration: Comparison of its Registration Process with Australia, Canada, Saudi Arabia and Singapore. Pharm Med. 2017;31(1):21–30. Heald A, Bramham-Jones S, Davies M. Comparing cost of intravenous infusion and subcutaneous biologics in COVID-19 pandemic care pathways for rheumatoid arthritis and inflammatory bowel disease: A brief UK stakeholder survey. Int J Clin Pract. 2021;75(9):e14341. Byun HG, Jang M, Yoo HK, Potter J, Kwon TS. Budget Impact Analysis of the Introduction of Subcutaneous Infliximab (CT-P13 SC) for the Treatment of Rheumatoid Arthritis in the United Kingdom. Appl Health Econ Health Policy. 2021;19(5):735–45. Yoo HK, Byun HG, Caprioli F, Fumery M, Peyrin-Biroulet L, Sreedhar S, et al. Budget impact analysis of the subcutaneous infliximab (CT-P13 SC) for treating inflammatory bowel disease in the Big-5 European (E5) countries. BMC Health Serv Res. 2022;22(1):1319. Kavanaugh A, Krueger GG, Beutler A, Guzzo C, Zhou B, Dooley LT, et al. Infliximab maintains a high degree of clinical response in patients with active psoriatic arthritis through 1 year of treatment: results from the IMPACT 2 trial. Ann Rheum Dis. 2007;66(4):498–505. Mao EJ, Hazlewood GS, Kaplan GG, Peyrin-Biroulet L, Ananthakrishnan AN. Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther. 2017;45(1):3–13. Fasanmade AA, Adedokun OJ, Ford J, Hernandez D, Johanns J, Hu C, et al. Population pharmacokinetic analysis of infliximab in patients with ulcerative colitis. Eur J Clin Pharmacol. 2009;65(12):1211–28. National Institute for Health and Care Excellence. Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed [Internet]. 2016. Available from: https://www.nice.org.uk/guidance/ta375 ClinicalTrial.gov. CT-P13 (Infliximab) Subcutaneous Administration in Patients with Moderately to Severely Active Ulcerative Colitis (LIBERTY-UC). 2023. ClinicalTrial.gov. A Phase I/III Study to Evaluate Efficacy, PK and Safety Between infliximab SC and infliximab IV in Patients With Active RA [Internet]. 2020. Available from: https://clinicaltrials.gov/study/NCT04205643 Qiu Y, Chen BL, Mao R, Zhang SH, He Y, Zeng ZR, et al. Systematic review with meta-analysis: loss of response and requirement of anti-TNFα dose intensification in Crohn's disease. J Gastroenterol. 2017;52(5):535–54. Savelkoul EHJ, Thomas PWA, Derikx L, den Broeder N, Römkens TEH, Hoentjen F. Systematic Review and Meta-analysis: Loss of Response and Need for Dose Escalation of Infliximab and Adalimumab in Ulcerative Colitis. Inflamm Bowel Dis. 2023;29(10):1633–47. World Population Review. Jordan Population 2024 [Internet]. 2024. Available from: https://worldpopulationreview.com/countries/jordan Institute for Health Metrics and Evaluation. Global Burden of Disease (GBD) [Internet]. 2024. Available from: https://ghdx.healthdata.org/ Central Bank of Jordan. Re-Discount Rate [Internet]. 2024. Available from: https://www.cbj.gov.jo/default/en Alkhatib NS, Almutairi AR, Almadi M, Halloush S, Al-Ruthia YSH, Rashdan O, et al. Budget impact analysis of subcutaneous infliximab (CT-P13 SC) for treating inflammatory bowel disease in Saudi Arabia: Analysis from payer perspective. PLoS ONE. 2024;19(11):e0312603. Mortaki K, Rigopoulos P, Stratopoulos A, Avgerinou M, Kougioumtzoglou I. EE76 Budget Impact of Subcutaneous Infliximab in Comparison to Intravenous Infliximab in the Management of Autoimmune Diseases in Greece. Value Health. 2022;25(12):S68. Yoo HK, Byun HG, Caprioli F, Fumery M, Peyrin-Biroulet L, Sreedhar S, et al. Budget impact analysis of the subcutaneous infliximab (CT-P13 SC) for treating inflammatory bowel disease in the Big-5 European (E5) countries. BMC Health Serv Res. 2022;22(1):1319. Pradie M, Hadjadj C, Petiteau Moreau F. POSB105 Budget Impact Analysis of Introduction of Subcutaneous Infliximab in France from a Payer Perspective. Value Health. 2022;25(1):S81. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Mar, 2026 Reviewers agreed at journal 25 Feb, 2026 Reviewers agreed at journal 23 Feb, 2026 Reviewers invited by journal 18 Feb, 2026 Editor assigned by journal 31 Dec, 2025 Submission checks completed at journal 31 Dec, 2025 First submitted to journal 24 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8442562","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":594823071,"identity":"127ad508-f40b-48e0-9baf-bf54b1557564","order_by":0,"name":"Rimal Mousa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBADOcYGIMnDwMBMtBZj0rUkgnSAtBAG5g3ciY95/tilN89IYHzwto2BnZ+QFpkDvJuNeduScxtnJDAbzm1jYJZsIKBFgoF3mzRvAzNIC5s0L1CLwQFitPD8qU9nnJHA/psELWyHE4Ba2JiJ08LMuxnoheOGjT0PmyXnnJMgwi/svRsfvPlTLW/Ynnzww5sym2SCIQaPOsMGcGRKJBPUAQfyUNqOeC2jYBSMglEwUgAAMqc0N9WuQZQAAAAASUVORK5CYII=","orcid":"","institution":"University of Jordan","correspondingAuthor":true,"prefix":"","firstName":"Rimal","middleName":"","lastName":"Mousa","suffix":""},{"id":594823072,"identity":"b98a76dc-b3b4-4e66-a0a5-a5e03931c461","order_by":1,"name":"Shiraz Halloush","email":"","orcid":"","institution":"Applied Science Private University","correspondingAuthor":false,"prefix":"","firstName":"Shiraz","middleName":"","lastName":"Halloush","suffix":""},{"id":594823073,"identity":"ed59f08b-d322-4948-9485-201f382ec378","order_by":2,"name":"Farah Radaydeh","email":"","orcid":"","institution":"PathEconomic LLC","correspondingAuthor":false,"prefix":"","firstName":"Farah","middleName":"","lastName":"Radaydeh","suffix":""},{"id":594823074,"identity":"55668076-9da8-46a9-b725-2ac939a5f5a0","order_by":3,"name":"Majed S. Al Yami","email":"","orcid":"","institution":"King Saud bin Abdulaziz University for Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Majed","middleName":"S. Al","lastName":"Yami","suffix":""},{"id":594823076,"identity":"4070e1ea-18ae-4d58-acbc-6be818263d19","order_by":4,"name":"Samar Melhem","email":"","orcid":"","institution":"University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Samar","middleName":"","lastName":"Melhem","suffix":""},{"id":594823077,"identity":"3ce2123e-3155-47a3-a274-acc1c24dc436","order_by":5,"name":"Bander Balkhi","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Bander","middleName":"","lastName":"Balkhi","suffix":""},{"id":594823078,"identity":"a4027c4e-5ec6-482d-b7f7-725cfbf3762b","order_by":6,"name":"Amanj Kurdi","email":"","orcid":"","institution":"University of Strathclyde","correspondingAuthor":false,"prefix":"","firstName":"Amanj","middleName":"","lastName":"Kurdi","suffix":""},{"id":594823082,"identity":"b9bcadea-fd59-435a-bcba-cbd37a9e0583","order_by":7,"name":"Nimer S. Alkhatib","email":"","orcid":"","institution":"Al-Zaytoonah University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Nimer","middleName":"S.","lastName":"Alkhatib","suffix":""}],"badges":[],"createdAt":"2025-12-24 12:08:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8442562/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8442562/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103338727,"identity":"a3dcfae1-f30a-4962-99d7-62edb94e8a31","added_by":"auto","created_at":"2026-02-24 15:08:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27590,"visible":true,"origin":"","legend":"\u003cp\u003eThe prevalence budget Impact of adoption of IFX SC across six ADs in Jordan: Base‑case analysis\u003c/p\u003e","description":"","filename":"FiguresInflix1.png","url":"https://assets-eu.researchsquare.com/files/rs-8442562/v1/4a3f447e754a7b1f9d285557.png"},{"id":103338725,"identity":"6f42fd8b-0cfd-4266-923f-ad86778a265a","added_by":"auto","created_at":"2026-02-24 15:08:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":199500,"visible":true,"origin":"","legend":"\u003cp\u003eSensitivity analysis for the base cases in six indications\u003c/p\u003e","description":"","filename":"FiguresInflix2.png","url":"https://assets-eu.researchsquare.com/files/rs-8442562/v1/30220b027afcead7731bd693.png"},{"id":103506361,"identity":"28f13334-7375-4e5e-b53d-fc595eccc7bc","added_by":"auto","created_at":"2026-02-26 13:35:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1882261,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8442562/v1/42b8a9db-19e8-4dfe-b18b-f6403350d282.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eBudget Impact Analysis of Subcutaneous Infliximab (CT-P13 SC) for Treating Autoimmune Diseases in Jordan\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAutoimmune diseases (ADs) are a group of autoinflammatory diseases caused by the immune system's antibodies attacking itself. These diseases can affect practically every organ in the body and develop at any level throughout a person's life (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The global prevalence of ADs is significantly increasing, partly due to changes in contact with environmental factors. This development carries significant implications for the health-related quality of life of families and patients, as well as impacting health-related expenditures (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).The estimated prevalence of ADs in the USA is around 5%, while in Europe, it is estimated to be approximately 10% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Nevertheless, there is a limited data on the prevalence of ADs in the Middle East, especially in Jordan (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Managing these ADs is difficult, requiring a balance between enhancing the quality of life and slowing the progression of the disease (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBiologics play a crucial role in suppressing the inflammatory pathways associated with various ADs. In Europe, current approved biological treatments include tumor necrosis factor inhibitors (TNFi) therapies (such as adalimumab, infliximab, and golimumab), anti-integrin agents (like vedolizumab), and anti-IL-12/23 agents (such as ustekinumab)(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). TNF, a monoclonal antibody targeting TNF-alpha, is considered a treatment of choice for various types of ADs, including inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn's disease (CD), rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and psoriasis (PS). The US Food and Drug Administration (FDA) has approved five TNF inhibitors\u0026mdash;adalimumab, infliximab, etanercept, golimumab, and certolizumab\u0026mdash;for diverse indications. These drugs can be prescribed alone or in conjunction with other agents such as methotrexate, Prednisone, sulfasalazine, leflunomide, and hydroxychloroquine (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIntravenous infliximab (IFX, Remicade) was the first TNFi approved for RA and IBD (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). It currently stands as one of the most prescribed treatments for these conditions. Although they are innovative and effective, biologics such as IFX tend to be more expensive than traditional treatments, thereby limiting their usage. Therefore, the availability of low-cost biosimilars has increased access to these highly effective medications. The European Commission for Medicines Agency (EMA) and the US FDA have approved CT-P13 as the first intravenous IFX biosimilar for the treatment of IBD and RA in 2013 and 2016 (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), respectively, followed by the approval of the first IFX subcutaneous (SC) formulation, CT-P13 SC in Europe, for the same indications as the reference IFX and its IV biosimilar in 2019 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe presence of CT-P13 SC could be a potential cost saving from the health care provider perspective partly due to reducing outpatient visits and the costs associated with intravenous (IV) administration in addition to the noninferiority results in term of efficacy and safety that was proved as compared to the IV form of CT-P13 in several Phase I/III randomized clinical trials recruited patients with active UC, CD (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and severe RA (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), respectively.\u003c/p\u003e \u003cp\u003eJordan was classified recently as an upper-middle-income country according to the World Bank classification in 2022\u0026ndash;2023, with a Gross Domestic Product (GDP) per capita of 4,311 US dollars in 2022 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), of which 7.98% of its GDP is dedicated to health care expenditure as compared to 5.63% of GDP in other upper-middle-income countries (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Pharmaceuticals contributed to 23.13% of Jordan\u0026rsquo;s total health expenditures in 2017, according to the Jordan National Health Account (NHA), with a significant part of the expenditures spent on biologics (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). As a developing country in the Middle East and North Africa (MENA) region, Jordan faces challenges in utilizing the costly biological medications because of their high costs due to the high out-of-pocket costs or premiums the patients should pay out to health insurance companies to cover their health care costs, and therefore, biosimilars provide a great cost-saving potential (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Jordan had a high rate of biosimilar approval share versus originators, which is comparable to other high-income countries in the Middle East, such as KSA, UAE (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The first IFX IV biosimilar was approved in 2014 by the Jordan Food and Drug Administration (JFDA), permitted (manufacturer: Celltrion, marketing authorization holder: Hikma Pharmaceuticals LLC) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). IFX SC has the potential to significantly reduce the health care administration costs related to staff time and consumables, as compared to IV IFX, in addition to improving work productivity for patients by minimizing the time spent in clinic visits (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, it is useful to quantify the potential cost savings associated with the introduction of SC option. A UK budget impact analysis of IFX SC for RA showed significant cost reductions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Moreover, Unexpected cost savings were seen in four of the big-5 European countries\u0026mdash;the UK, Germany, France, and Italy\u0026mdash;but not in Spain, according to a budget impact assessment of using IFX SC for the treatment of IBD over a 5-year time horizon (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the economic burden of biologics, country-specific budget impact analyses are important to inform payer and formulary decisions. Accordingly, this study aims to evaluate the budgetary impact of introducing IFX SC in Jordan compared with IV IFX (both originator Remicade and biosimilar Remsima) for six indications: RA, UC, CD, AS, PsA, and PS, from the public payer perspective.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eModel structure\u003c/h2\u003e \u003cp\u003eA prevalence-based budget impact model (BIM) was constructed to investigate the financial impact of adding IFX SC to the currently available IV IFX (including originator and biosimilars) for treatment of RA, UC, CD, AS, PsA, and PS as per indication in the Jordanian market from a payer perspective.\u003c/p\u003e \u003cp\u003eTwo scenarios were performed and compared to the base case analysis as follows\u003c/p\u003e \u003cp\u003eBase case analysis: Current treatment environment, including World without biosimilar IFX SC (i.e., only the presence of IFX originators and their IV biosimilars)\u003c/p\u003e \u003cp\u003e1st scenario: World with total adoption of Future treatment environment, i.e. total adoption of IFX\u0026rsquo;s biosimilar instead of the current treatment environment (i.e., IFX originators and their IV biosimilars)\u003c/p\u003e \u003cp\u003e2nd scenario: World with gradual adoption of IFX SC Future treatment environment, i.e. IFX\u0026rsquo;s biosimilar is added to the current treatment environment based on the Jordanian Market share derived from the Government Procurement Department (GPD).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTime horizon\u003c/h3\u003e\n\u003cp\u003eThe scenario was developed for a 5-year horizon. The time horizon chosen is sufficient to observe the impacts of SC infliximab\u0026rsquo;s biosimilar implementation on the health care budget over the next year following the uptake, since the share of the biosimilar is expected to increase over the upcoming years in the public sector.\u003c/p\u003e\n\u003ch3\u003eModel Assumptions\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDosing information and treatment assumptions\u003c/h2\u003e \u003cp\u003eThe dosing information indicated to treat adult patients with TNFi for each indication was obtained from the summary of product characteristics (SmPC) Average patients\u0026rsquo; weights used to estimate the total dose regimen for each indication were consistent with previous literature (\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Drugs\u0026rsquo; vials were assumed not to be considered for vial sharing, and no wastage is considered for the same patient. All patients were assumed to receive an induction of an IV loading dose of infliximab six weeks ahead, followed by maintenance schedules in the subsequent years. This is to reflect the clinical trial phase III protocol and the most common practices on IFX SC and IV available in the literature (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Moreover, SC IFX was assumed to be non-inferior to IV in terms of efficacy and safety based on comparable results in phase I and III double-blinded randomized trials (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Dose escalation rates for IFX were adopted as reported by the published systematic reviews and meta-analysis by Savelkoul 2022 and Qiu 2017 for adult patients with UC and CD (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNumber of patients eligible for biological treatments\u003c/h3\u003e\n\u003cp\u003eThe number of patients eligible for infliximab treatment was calculated by multiplying the number of the Jordanian population (11.4\u0026nbsp;million) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) by the prevalence rate of each AD (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and the proportion of patients eligible to receive the infliximab regimen for each AD. The Jordanian population data were extracted from the Office for National Statistics (ONS) databases (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and the prevalence rate was obtained from the Institute for Health Metrics and Evaluation (IHME) databases (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The latter percentage was obtained by multiplying the proportion of patients eligible for bDMARDs by the market share of infliximab among bDMARDs, obtained from the Jordanian GPD (29%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) for patients with RA, PsA, AS. For patients with UC and CD, patients were eligible if they had moderately or severely active CD or UC with an inadequate response to conventional therapy (including corticosteroids, 6-mercaptopurine, or azathioprine) who were intolerant to or had medical contraindications for these therapies. Details used to calculate the eligibility rate for CD and UC are provided in Supplementary Table\u0026nbsp;1. To account for the new patients diagnosed with each AD over the forthcoming 5 years, the annual prevalence data were adjusted by incorporating a projected yearly incidence rate. These projections were based on population trends and provide a foundation for estimating based on the prevalence data from the past five years obtained from the IHME, form the basis for estimating the projected prevalence of the six target indications evaluated in this study, as presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe number of patients eligible to receive the infliximab regimen for each Autoimmune disease\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalculations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndication criterion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11,400,000.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePopulation inJordan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eJordan Population 2024 (Live) (worldpopulationreview.com)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eThe number of patients eligible for bDMARDs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e\u003cb\u003eRheumatoid arthritis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14,387.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevalence of RA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIHME data2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage of patients eligible for Biological DMARD (With severe, active and progressive disease and unresponsive to conventional DMARD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssumed it is the same as the consumption of BDMARD among Jordanian patients diagnosed with RA \u003c/p\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.29333/ejgm/13521\u003c/span\u003e\u003cspan address=\"10.29333/ejgm/13521\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdult patients not previously treated with methotrexate or other DMARDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOlsen IC, Lie E, Vasilescu R, Wallenstein G, Strengholt S, Kvien TK. Assessments of the unmet need in the management of patients with rheumatoid arthritis: analyses from the NOR-DMARD registry. Rheumatology. 2018;58(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e):481\u0026thinsp;\u0026minus;\u0026thinsp;91.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith severe, active and progressive disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarpenter L, Nikiphorou E, Norton S, Jayakumar K, Dixey J, Young A. Patients with moderate disease activity in the first 5 years of rheumatoid arthritis still progress radiographically despite conventional disease modifying therapy.: 2135. Arthritis \u0026amp; Rheumatology. 2014;66.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSum of patients eligible for biological DMARD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.03%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient share of infliximab among bDMARDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJoint procurement department\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll patients with RA require infliximab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,766.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal with RA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIBD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,740.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevalence of IBD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIHME data2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eUlcerative colitis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmong IBD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/34227982/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/34227982/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerately to severely active ulcerative colitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe facts about inflammatory bowel diseases: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf\u003c/span\u003e\u003cspan address=\"https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e \u003c/p\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127456/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127456/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-MP) or azathioprine (AZA), or who are intolerant to or have medical contraindications for such therapies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssumed the same as in Crohn's disease. \u003c/p\u003e \u003cp\u003eThe Cochrane Library 2016. Azathioprine or 6-mercaptopurine for induction of remissionin Crohn\u0026rsquo;s disease (Review): https://www.cochranelibrary.com/cdsr/doi/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD000545.pub5/epdf/standard\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD000545.pub5/epdf/standard\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003e is stated that: \"There was no statistically significant difference in clinical remission rates between azathioprine or 6-mercaptopurine and placebo. Forty-eight per cent (95/197) of patients receiving antimetabolites achieved remission compared to 37% (68/183) of placebo patients (5 studies,380 patients; RR 1.23, 95% CI 0.97 to 1.55)\".\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eof all people with UC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e439.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e\u003cb\u003eCrohn's disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmong IBD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/34227982/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/34227982/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.01%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerately to severely active Crohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCosnes 2012 (France): \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://gut.bmj.com/content/gutjnl/61/8/1140.full.pdf\u003c/span\u003e\u003cspan address=\"https://gut.bmj.com/content/gutjnl/61/8/1140.full.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eSource\u003c/span\u003e\u003cspan address=\"http://Source\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e data: people with severe CD (321/600) with active disease (median 43%)\u003c/p\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127456/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11127456/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-MP) or azathioprine (AZA), or who are intolerant to or have medical contraindications for such therapies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe Cochrane Library 2016. Azathioprine or 6-mercaptopurine for induction of remissionin Crohn\u0026rsquo;s disease (Review): https://www.cochranelibrary.com/cdsr/doi/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD000545.pub5/epdf/standard\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD000545.pub5/epdf/standard\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003e is stated that: \"There was no statistically significant difference in clinical remission rates between azathioprine or 6-mercaptopurine and placebo. Forty-eight per cent (95/197) of patients receiving antimetabolites achieved remission compared to 37% (68/183) of placebo patients (5 studies,380 patients; RR 1.23, 95% CI 0.97 to 1.55)\".\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e11.96%\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSub total\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFistulising, active Crohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGecse 2013 (US): \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040755/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040755/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-MP) or azathioprine (AZA), or who are intolerant to or have medical contraindications for such therapies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe Cochrane Library 2016. Azathioprine or 6-mercaptopurine for induction of remissionin Crohn\u0026rsquo;s disease (Review): https://www.cochranelibrary.com/cdsr/doi/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD000545.pub5/epdf/standard\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD000545.pub5/epdf/standard\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003e is stated that: \"There was no statistically significant difference in clinical remission rates between azathioprine or 6-mercaptopurine and placebo. Forty-eight per cent (95/197) of patients receiving antimetabolites achieved remission compared to 37% (68/183) of placebo patients (5 studies,380 patients; RR 1.23, 95% CI 0.97 to 1.55)\".\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e18.20%\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSub total\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eof all people with CD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBecause the two groups overlap to a certain extent, the largest value was considered.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e344.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal number of CD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71,936.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevalence of AS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK532288/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK532288/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSevere, active ankylosing spondylitis (BASDAI\u0026thinsp;\u0026ge;\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNICE technology appraisal 383, 2014: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nice.org.uk/guidance/ta383/chapter/4-Committee-discussion\u003c/span\u003e\u003cspan address=\"https://www.nice.org.uk/guidance/ta383/chapter/4-Committee-discussion\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients who responded inadequately to conventional therapy (NSAIDs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBaraliakos 2017 (Germany): \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://academic.oup.com/rheumatology/article/56/1/95/2444589\u003c/span\u003e\u003cspan address=\"https://academic.oup.com/rheumatology/article/56/1/95/2444589\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient share of infliximab among bDMARDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGovernment Procurement Department\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eof all people with AS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,506.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal number of AS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsoriatic arthritis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69,225.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevalence of Psoriasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIHME data2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage of psoriatic patients with psoriatic arithritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00296-019-04319-3\u003c/span\u003e\u003cspan address=\"10.1007/s00296-019-04319-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eActive and progressive psoriatic arthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDisease Activity index for Psoriatic arthritis scores for 2017 from: https://arthritis-research.biomedcentral.com/articles/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13075-018-1659-z/figures/1\u003c/span\u003e\u003cspan address=\"10.1186/s13075-018-1659-z/figures/1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62.39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ein adult patients when the response to previous DMARD therapy has been inadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWilsdon 2011 (Australia): \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pubmed/30656673\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pubmed/30656673\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eSource\u003c/span\u003e\u003cspan address=\"http://Source\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e data: Methotrexate reponse rate 41/109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient share of infliximab among bDMARDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGovernment Procurement Department\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48.66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eof all people with PsA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,930.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal number with PsA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePsoriasis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69,249.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsoriasis in jordan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIHME data2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate to severe plaque psoriasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombo 2013: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hindawi.com/journals/tswj/2013/805705/\u003c/span\u003e\u003cspan address=\"https://www.hindawi.com/journals/tswj/2013/805705/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdult patients who failed to respond to, or who have a contraindication to, or are intolerant to other systemic therapy including cyclosporine, methotrexate or psoralen ultra-violet A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWest 2016: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864230/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864230/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eMTX\u003c/span\u003e\u003cspan address=\"http://MTX\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e response 45.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePatient share of infliximab among biologicals\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eGovernment Procurement Department\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe projected annual number of cases diagnosed (prevalence number) with the six ADs over the 5-year period \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevalence (number) (mean (95%CI))\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrohn's\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePsA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePsoriasis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e439.97\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(437.81,442.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e344.75\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(343.06,346.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1766.28\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1760.75,1771.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4491.99\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1771.81,4506.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2750.33\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2749.37,2751.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2929.61\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2751.3,2930.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e460.67\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(458.37,462.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e360.97\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(359.17,362.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1851.33\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1845.42,1857.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4708.02\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1857.24,4723.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2865.21\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2864.18,2866.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3051.95\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2866.24,3053.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e481.37\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(478.86,483.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e377.20\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(375.23,379.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1936.38\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1929.94,1942.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4923.62\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1942.83,4940.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2980.09\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2978.96,2981.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3174.26\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2981.21,3175.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e502.08\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(499.29,504.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e393.42\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(391.23,395.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2021.44\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2014.28,2028.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5138.81\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2028.59,5157.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3094.96\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(3093.71,3096.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3296.54\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(3096.21,3297.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2028\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e522.78\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(519.65,525.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e409.64\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(407.19,412.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2106.49\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2098.47,2114.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5353.59\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(2114.51,5374.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3209.84\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(3208.44,3211.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3418.78\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(3211.24,3420.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Note: \u003cb\u003eAD\u003c/b\u003e: Autoimmune Disease, \u003cb\u003eUC\u003c/b\u003e: Ulcerative Colitis; \u003cb\u003eRA\u003c/b\u003e: Rheumatoid Arthritis; \u003cb\u003eAS\u003c/b\u003e: Ankylosing Spondylitis; \u003cb\u003ePsA\u003c/b\u003e: Psoriatic Arthritis\u003c/p\u003e \u003cp\u003ePrevalence of each disease estimated as the total number of cases in the Jordanian population\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMarket share for biological treatments\u003c/h2\u003e \u003cp\u003eThe market share for the infliximab\u0026rsquo;s biosimilars and its originator for both worlds with/out Remsima SC was calculated in consistent with the consumption observed in GPD, which was used to calculate the patients' share of infliximab\u0026rsquo;s biosimilar and its comparators.\u003c/p\u003e \u003cp\u003eThe model computed the market share of the following biologics, including Infliximab\u0026rsquo;s biosimilars (Remsima SC and Remicade), and Remsima (Originator). The share of Remsima SC was taken from the Remsima IV and Remicade IV. This share assumption was based on the previous GPD data over the last 5 years and experts' opinions as well. The GPD data reflect the total consumption of each biological that is distributed to the public sectors, including the Royal Medical Service, the Ministry of Health, and Jordan University Hospital. For example, the 10% share of Remsima SC was taken from Remsima IV (0.095) and Remicade IV (0.005), increasing up to 50% in Year 5. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the market share for the Infliximab formulations available in Jordan over the 5-year time horizon.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe market share for the Infliximab formulations available in Jordan over the 5-year time horizon\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInfliximab formulations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eMarket share (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBase case scenario \u003c/p\u003e \u003cp\u003e (without)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eScenario with\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYear 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYear 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYear 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYear 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYear 5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfliximab SC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfliximab IV (Remicade)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfliximab IV (Remsima)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDisease-related costs\u003c/h3\u003e\n\u003cp\u003eThe study was conducted from Health care payer perspective. The model estimated the direct medical cost including drug acquisition cost in addition to the administration costs of the services associated with the route of administration including (staff time, associated usage of local anesthesia), the costs were obtained from tendering price, which reflects of GDP data the real life managed entry agreement financial mechanisms that were endorsed by the GDP department for the public sector. A 4.75% discount rate to future costs was also applied to reflect the costs and benefits accruing over the 5-year time horizon from 2024 to 2028, based on the Jordanian central bank (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eAnnual drug costs were estimated by multiplying the number of doses per year by the number of units per dose by the average costs per unit. Average costs per unit had been calculated by multiplying the mg per unit by the price per mg. The total annual costs for the Initial year are different from the maintenance years, reflecting higher dose requirements in the first year of treatment. The costs were reported in 2024 Jordanian Dinar (JD). An exchange rate of 1 JD\u0026thinsp;=\u0026thinsp;1.41 USD (December 2025) was used.\u003c/p\u003e\n\u003ch3\u003eTotal budget impact\u003c/h3\u003e\n\u003cp\u003eThe net budget impact and savings of adopting IFX SC into the Jordanian market were calculated by subtracting the total cost of the \u0026ldquo;world without\u0026rdquo; from the \u0026ldquo;world with\u0026rdquo; scenarios. In the base-case analysis, the drug acquisition and administration costs were used to estimate the total costs for each comparator in each scenario and then were multiplied by the number of patients and weighted by their market share.\u003c/p\u003e \u003cp\u003eThe following equation was used to compute the annual savings:\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnnual Budget Impact\u0026thinsp;=\u0026thinsp;annual associated treatment cost using future environment - annual associated treatment cost using current environment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAdditional potential patients to expand access to the newer treatment were calculated each year by dividing the annual budget savings by the total costs associated with Remsima SC each year, per each AD.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAdditional potential patients = (Annual budget Savings of the switching from Remsima IV or Remicade to Remsima SC) \u0026divide; (treatment cost associated with Remsima SC)\u003c/b\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSensitivity analysis\u003c/h2\u003e \u003cp\u003eDeterministic sensitivity analyses were conducted to test the robustness of base case results to any variation of key input parameters, such as the estimates of each disease prevalence around their ranges, discount rates, and price erosion. These were presented as a tornado diagram showing the impact of changing key parameters in the budget impact model.\u003c/p\u003e \u003cp\u003eThe sensitivity analyses were conducted using Microsoft Excel\u0026reg;.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBase Case\u003c/h2\u003e \u003cp\u003eThe base case analysis estimated the budget impact of adopting CT-P13 SC over 5-year time horizon in six indications of ADs in Jordan. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes the net budget, budget impact of introducing IFX SC, and potential additional patients across different indications in ADs\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eTotal budget impact and number of additional patients following the adoption of IFX SC across six ADs in Jordan\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYear 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYear 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYear 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYear 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYear 5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eUC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal net budget\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,005.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,185.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,157.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,130.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3,102.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17,580.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBudget Impact per patient (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-250.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2,070.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2,098.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2,125.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2,153.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-8,698.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrevalence Budget Impact (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-110,268.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-953,988.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,010,049.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1,067,244.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1,125,574.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-4,267,126.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber of additional patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eCrohn\u0026rsquo;s\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal net budget\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,013.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,337.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,291.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,990.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,986.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17,619.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBudget Impact per patient (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-251.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,927.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,973.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2,274.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2,279.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-8,706.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrevalence Budget Impact (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-86,731.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-695,759.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-744,569.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-894,995.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-933,578.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3,355,633.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber of additional patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,133.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eRA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal net budget\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,132.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,392.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,464.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,535.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,607.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13,132.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBudget Impact per patient (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-42.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-782.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-711.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-639.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-567.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2,743.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrevalence Budget Impact (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-75,175.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,449,331.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,377,114.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1,292,703.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1,196,098.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-5,390,423.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber of additional patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ePsoriasis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal net budget\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,002.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,571.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,495.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,420.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3,344.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18,833.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBudget Impact per patient (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-250.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,680.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,756.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1,832.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1,907.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-7,427.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrevalence Budget Impact (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-688,319.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4,815,548.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-5,234,280.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5,670,410.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-6,123,938.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-22,532,497.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber of additional patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7,616\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ePsA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal net budget\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,002.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,718.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,716.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,714.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3,712.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19,865.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBudget Impact per patient (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-250.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,533.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,535.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1,537.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1,539.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-6,395.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrevalence Budget Impact (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-733,445.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4,681,313.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-4,875,468.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5,070,122.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-5,265,273.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-20,625,624.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber of additional patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1,775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6,974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal net budget\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,528.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,969.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,968.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,968.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,967.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16,401.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBudget Impact per patient (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-73.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,632.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,633.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1,633.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1,633.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-6,606.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrevalence Budget Impact (JD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-330,987.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-7,711,051.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-8,067,297.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-8,069,290.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8,780,315.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-32,958,942.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber of additional patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11,087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003e Note: \u003cb\u003eAD\u003c/b\u003e: Autoimmune Diseases; \u003cb\u003eUC\u003c/b\u003e: Ulcerative Colitis; \u003cb\u003eRA\u003c/b\u003e: Rheumatoid Arthritis; \u003cb\u003eAS\u003c/b\u003e: Ankylosing Spondylitis; \u003cb\u003ePsA\u003c/b\u003e: Psoriatic Arthritis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOverall, the total net budget in the world with SC Remsima was lower than that in the world without SC Remsima. In both the \u0026ldquo;world with\u0026rdquo; and \u0026ldquo;world without\u0026rdquo; scenarios. This reduction was justified largely due to administration cost savings. The slightly higher drug acquisition cost of the SC formulation was offset by its lower administration as compared to that of the IV formulation. The prevalence budget impact is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The lowest budget impact was noticed in year 1, due to the lowest market share, with more cost savings being noticed over the consecutive years, likely due to the increasing market uptake rate. The largest cost-savings over the 5-year period were seen among Psoriasis, PsA and AS, ranging from nearly \u0026ndash; 20.6\u0026nbsp;million JD to \u0026ndash; 32.9\u0026nbsp;million JD (equivalent to \u0026ndash; 29\u0026nbsp;million USD to \u0026ndash; 46.4\u0026nbsp;million USD), while the lowest numbers were see in RA, UC and Crohn\u0026rsquo;s disease, ranging from nearly \u0026ndash; 3.3\u0026nbsp;million JD to \u0026ndash; 5.3\u0026nbsp;million JD (equivalent to \u0026ndash; 4.7\u0026nbsp;million USD to \u0026ndash; 7.6\u0026nbsp;million USD). For example, over 5 years a total of \u0026minus;\u0026thinsp;4,267,126.80 JD (\u0026ndash;6,016,648.79 USD) was saved among patients with UC, ranging from \u0026minus;\u0026thinsp;110,268.96 JD (\u0026ndash;155,479.23 USD) in year 1 to \u0026minus;\u0026thinsp;1,125,574.48 JD (\u0026ndash;1,587,060.02 USD) in year 5. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the budget impact of introducing Remsima SC in the market over 5 years in six indications.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe budget impact analysis conducted over five years reveals compelling insights into the economic implications of the adoption of SC Remsima for treating the six indications in Jordan. The introduction of infliximab biosimilar SC alongside other infliximab formulations demonstrates substantial cost savings, emphasizing the potential for healthcare systems to allocate resources more effectively. Additionally, while SC Remsima exhibits a slightly higher cost compared to the biosimilar, it still contributes noteworthy savings, primarily attributable to its reduced administration costs. This highlights CT-P13 SC as a viable treatment option, especially for patients who may benefit from its specific formulation. The cost per patient for each indication is detailed in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, showcasing the financial implications associated with each treatment option and underscoring the importance of making informed decisions to enhance patient care while managing healthcare expenditures efficiently.\u003c/p\u003e \u003cp\u003eMoreover, the number of additional patients eligible for expanding treatment access that results from conversion to the more cost-saving budget is illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Overall, the number of potential patients increased over the subsequent years. For example, for patients with RA, the number increased from 27 in year 1 to 403 in year 5. The number of patients is dramatically increasing in highly prevalent diseases such as psoriasis, PsA, and AS. The number of patients with Psoriasis increased from 250 in year 1 to 2,065 in year 5. The highest budget impact per patient was seen in IBD, approximately \u0026ndash; 8,700 JD (\u0026ndash; 12,267 USD) in both UC and Crohn\u0026rsquo;s disease), while the lowest impact per patient of \u0026ndash; 2,744 JD (\u0026ndash; 3,869 USD) was seen in RA.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eOne‑Way Sensitivity Analysis\u003c/h2\u003e \u003cp\u003eThe results of the one-way sensitivity analysis are presented in Figure. 2. The variables are shown in decreasing order. Overall, the net budget impact of IFX SC was insensitive to any change of key parameters over their plausible ranges across the six indications, reflecting the robustness of the base case results. In the base case, the key parameters with the biggest impact over 5-year budget savings were the price erosion of IFX SC, followed by the discount rate, and prevalence of ADs (Figure. 2). For example, changing the price erosion for the IFX SC between (45% to 78%) results in a budget saving from \u0026minus;\u0026thinsp;26,478.07 JD to -1,298,894.00 JD in patients with Crohn\u0026rsquo;s disease.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first budget impact analysis addressing the use of subcutaneous Infliximab (CT-P13 SC) for treating autoimmune diseases in Jordan. Our results show that using IFX SC for six autoimmune diseases leads to substantial savings over five years. These savings are mainly driven by the lower administration costs of IFX SC compared to IV IFX.\u003c/p\u003e \u003cp\u003eThe prevalence of budget impact was the lowest for the six diseases during the first year due to the lowest market share. The utilization of IFX SC in AS, Psoriasis and PsA showed the largest cost savings over a five-year period: \u0026ndash; 32.9\u0026nbsp;million JD, \u0026ndash; 22.5\u0026nbsp;million JD and \u0026ndash; 20.6\u0026nbsp;million JD, respectively. On the other hand, the cost savings for RA, UC, and Crohn's disease were \u0026ndash; 5.3\u0026nbsp;million JD, \u0026ndash; 4.2\u0026nbsp;million JD and \u0026ndash; 3.3\u0026nbsp;million JD, respectively. The sensitivity analysis shows that our results are consistent regardless of any change to key parameters. Moreover, given that the number of additional patients increased over time, these findings underscore the significant economic impact of SC infliximab and the potential for expanding its utilization in Jordan across several autoimmune diseases.\u003c/p\u003e \u003cp\u003eThe results of this analysis are aligned with the findings from previous studies. A study from Saudi Arabia showed cost savings with the use of IFX SC in patients with UC and Crohn's disease reaching up to -31.9\u0026nbsp;million Saudi Riyal (SAR) in UC and \u0026minus;\u0026thinsp;106.2\u0026nbsp;million SAR in CD at 100% uptake (full adoption) over a two-year period (2021\u0026ndash;2023) based on an exchange rate of 1 JD\u0026thinsp;=\u0026thinsp;5.29 SAR (December 2025) (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In addition, two studies, one conducted in the UK and one in Greece, reported cost savings of around \u0026pound;69\u0026nbsp;million and \u0026euro;2\u0026nbsp;million in patients with RA and ADs respectively (1 JD = \u0026pound;1.06 = \u0026euro;1.21, December 2025) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). These findings show that reduced administration-related expenditures of IFX SC, regardless of the contrary economic status, will result in significant cost savings. Form healthcare providers perspective, switching from IV to SC infliximab in patients with IBD has shown a reduction in hospital visits, and time previously spent by nurses or technicians on IV infusions can be reallocated to other patients or services, optimizing resource utilization and potentially improving overall health care service delivery. In addition to the possibility of infliximab SC being self-administered at home due to the convenience of administering Infliximab SC, which may improve patients experience and satisfaction as well as their adherence to therapy and quality of life.\u003c/p\u003e \u003cp\u003eFurthermore, a five-year budget impact analysis of IFX SC for IBD (CD and UC) was conducted in five European countries (Germany, France, Italy, Spain, and the UK), revealing substantial cost savings, except in Spain, for CD, introducing IFX SC over a 5-year period resulted in cost savings of \u0026euro;42.0\u0026nbsp;million (UK), \u0026euro;59.4\u0026nbsp;million (Germany), and \u0026euro;46.4\u0026nbsp;million (France and Italy). In UC, 5-year saving were \u0026euro;42.7\u0026nbsp;million (UK), \u0026euro;44.9\u0026nbsp;million (Germany), \u0026euro;44.3\u0026nbsp;million (France), and \u0026euro;53.0\u0026nbsp;million (Italy) (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). In regards to Spain, modest savings were achieved in the first year followed by a rise in costs from year 2\u0026ndash;5, this can be attributed to a combination of pricing strategies and dosing practices, as CT-P13 SC was priced much higher than IV IFX, which ,alongside the progressive market uptake of IFX SC in years 2\u0026ndash;5, led to a slight increase in budget expenditure for CD and no savings for UC (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Similarly, a three-year budget impact analysis conducted in France (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) also concluded to a potential increase in costs upon replacing IV infliximab with SC, which is primarily a result of the higher acquisition cost of fixed-dose SC formulation relative to standard 5mg/kg IV dosing used in the study population. However, the sensitivity analysis showed a potential cost saving for patients using more than the standard dosage (IV dose escalation) or with a different pricing condition (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTaken together, the findings of our analysis are broadly consistent with the growing body of international evidence evaluation the economic impact of IFX SC across diverse healthcare systems. Studies have uniformly demonstrated that IFX SC generates worthy cost savings when administration costs are substantial or when dose escalation is common (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Even in settings such as Spain or France where IFX SC was associated with increased expenditures under base-case assumptions, sensitivity analysis showed that pricing strategies and market uptake dynamics can shift outcome towards cost savings (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis is the first budget impact analysis to address the use of IFX SC versus IV IFX in Jordanian patients with autoimmune diseases from a payer perspective. However, our analysis has some limitations worth addressing. The model structure incorporates direct costs, for example, drug acquisition and drug administration, and indirect costs from tendering price, which might affect our cost savings results. In addition, the market share for the evaluated biological treatments was obtained from the historical data in the GDP from Jordan and experts' opinions, which also directly affects our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that adoption of IFX SC has the potential to generate meaningful cost savings for the Jordanian healthcare payer regarding these six autoimmune diseases. The most significant savings per patient were mainly in UC and CD compared to other indications. These savings are primarily due to reductions in administration-related expenditures, while offering potential benefits in terms of patient convenience, reduced hospital visits and more efficient use of healthcare personnel time.\u003c/p\u003e \u003cp\u003eFrom a decision-making perspective these findings support considering IFX SC for reimbursement within the Jordanian healthcare system as it may help use healthcare resources more efficiently without increasing overall costs. Nevertheless, the results should be interpreted cautiously given the assumptions and data limitations of the model.\u003c/p\u003e \u003cp\u003eFuture studies are needed to address the uncertainties surrounding the convenience of administration, patient tolerability, physician acceptance to prescribe SC formulation of infliximab, and the real-world comparative effectiveness of IFX SC versus other tumor necrosis factor (TNF) inhibitors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADs, autoimmune diseases; AS, ankylosing spondylitis; bDMARDs, biologic disease-modifying antirheumatic drugs; BIM, budget impact model; CD, Crohn\u0026rsquo;s disease; EMA, European Medicines Agency; FDA, Food and Drug Administration; GDP, gross domestic product; GPD, Government Procurement Department; IBD, inflammatory bowel disease; IFX, infliximab; IHME, Institute for Health Metrics and Evaluation; IV, intravenous; JD, Jordanian dinar; JFDA, Jordan Food and Drug Administration; MENA, Middle East and North Africa; NHA, National Health Account; PS, psoriasis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SAR, Saudi riyal; SC, subcutaneous; SmPC, summary of product characteristics; TNFi, tumor necrosis factor inhibitors; UC, ulcerative colitis; USD, United States dollar.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e \u003cp\u003e Ethical approval to obtain the information needed to conduct this study was obtained from the Institutional Review Board of the Jordanian Ministry of Health research committee in accordance with the Declaration of Helsinki. No information was collected directly from patients and thus, consent forms were not collected on the patient level.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eR.M. carried out the study conception, design, data collection, analysis, budget impact modeling, and manuscript drafting. N.K helped in the study conception, design, data collection and modelling. B.B., S.M., A.K., F.R., M.Y. and S.H. contributed exclusively to the critical review and revision of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eOngoing Research Funding Program (ORF-2025-76), King Saud University, Riyadh, Saudi Arabia.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this published article. Additional supplementary data will be available upon request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFairweather D, Frisancho-Kiss S, Rose NR. Sex differences in autoimmune disease from a pathological perspective. Am J Pathol. 2008;173(3):600\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller FW. The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment, and prevention. 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Value Health. 2022;25(12):S68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoo HK, Byun HG, Caprioli F, Fumery M, Peyrin-Biroulet L, Sreedhar S, et al. Budget impact analysis of the subcutaneous infliximab (CT-P13 SC) for treating inflammatory bowel disease in the Big-5 European (E5) countries. BMC Health Serv Res. 2022;22(1):1319.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePradie M, Hadjadj C, Petiteau Moreau F. POSB105 Budget Impact Analysis of Introduction of Subcutaneous Infliximab in France from a Payer Perspective. Value Health. 2022;25(1):S81.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cost-effectiveness-and-resource-allocation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cera","sideBox":"Learn more about [Cost Effectiveness and Resource Allocation](http://resource-allocation.biomedcentral.com)","snPcode":"12962","submissionUrl":"https://submission.nature.com/new-submission/12962/3","title":"Cost Effectiveness and Resource Allocation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Budget Impact, Infliximab, Autoimmune disease, Jordan, Biosimilar","lastPublishedDoi":"10.21203/rs.3.rs-8442562/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8442562/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAutoimmune diseases are increasingly prevalent, and their management in Jordan relies heavily on costly intravenous infliximab (IV IFX). Subcutaneous infliximab (IFX SC) may offer cost savings by reducing administration-related expenses. This study aims to investigate the financial impact of adding IFX SC to the currently available IV IFX, including originator and biosimilars, for the treatment of six autoimmune diseases: rheumatoid arthritis (RA), ulcerative colitis (UC), Crohn's disease (CD), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and psoriasis (PS) in the Jordanian market from a payer perspective.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA prevalence-based budget impact model was constructed to compare the current treatment environment without IFX SC (base case) with two future scenarios over a 5-year time horizon; 1st scenario: total adoption of IFX SC, 2nd scenario: gradual adoption of IFX SC. The numbers of patients eligible for IFX originator and its biosimilar, in addition to market share adoption, were obtained from official websites. Sensitivity analyses were conducted using Microsoft Excel\u0026reg; to test the robustness of results to any variation of key input parameters,\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOver the 5-year horizon, the largest cost savings were observed in PS, PsA, and AS (\u0026ndash;20.6 to \u0026minus;\u0026thinsp;32.9\u0026nbsp;million JD; \u0026minus;\u0026thinsp;29.0 to \u0026minus;\u0026thinsp;46.4\u0026nbsp;million USD), while lower savings were seen in RA, UC, and CD (\u0026ndash;3.3 to \u0026minus;\u0026thinsp;5.3\u0026nbsp;million JD ( \u0026minus;\u0026thinsp;4.7 to \u0026minus;\u0026thinsp;7.6\u0026nbsp;million USD)). Conversion to the more cost-saving scenario enabled expansion of treatment access, with the number of eligible patients increasing over time, particularly in highly prevalent conditions such as PS, PsA, and AS. The highest budget impact per patient was observed in UC and CD (approximately \u0026minus;\u0026thinsp;8,700 JD (\u0026ndash;12,267 USD)), whereas the lowest was in RA (\u0026ndash;2,744 JD ( \u0026minus;\u0026thinsp;3,869 USD)).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn this study, there is a cost-saving potential with IFX SC use compared to IV IFX. These cost-savings, alongside the benefits of fewer hospital visits, additional eligible patients, and more efficient use of healthcare personnel time, support considerations of IFX SC reimbursement within the Jordanian healthcare system, while real-world evidence is needed to address uncertainties related to comparative effectiveness, patient tolerability and clinical acceptance.\u003c/p\u003e","manuscriptTitle":"Budget Impact Analysis of Subcutaneous Infliximab (CT-P13 SC) for Treating Autoimmune Diseases in Jordan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 15:08:00","doi":"10.21203/rs.3.rs-8442562/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-30T23:08:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266984416383707260348569835509446007375","date":"2026-02-25T15:24:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276698686105968667286247902366855652396","date":"2026-02-23T22:28:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-18T23:12:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-31T06:50:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-31T06:50:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cost Effectiveness and Resource Allocation","date":"2025-12-24T11:53:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cost-effectiveness-and-resource-allocation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cera","sideBox":"Learn more about [Cost Effectiveness and Resource Allocation](http://resource-allocation.biomedcentral.com)","snPcode":"12962","submissionUrl":"https://submission.nature.com/new-submission/12962/3","title":"Cost Effectiveness and Resource Allocation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"abe4ff2d-c729-46e6-9927-31b7b68dc0b6","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-24T15:08:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 15:08:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8442562","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8442562","identity":"rs-8442562","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}