Pharmacoeconomic Value of Precision-Guided High-Cost Therapies in Rheumatic and Autoimmune Diseases: A Systematic Review of Cost-Effectiveness, Budget Impact, and Decision Uncertainty

To identify, characterize, and critically appraise comparative economic evaluations and budget impact analyses of precision medicine strategies used to guide the use of high-cost medications for rheumatic and autoimmune diseases. The review will examine strategies based on biomarkers, pharmacogenomics, therapeutic drug monitoring, clinical decision rules, predictive models, machine learning, or artificial intelligence when the resulting information changes a treatment decision. The synthesis will cover incremental costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), net monetary benefit, cost savings, budget impact, affordability, value of information, and major sources of uncertainty, with particular attention to the transferability of findings to payers, health technology assessment (HTA) bodies, and public health systems.