Cost-Effectiveness Analysis of Abrocitinib Versus Dupilumab in Adolescents With Severe Atopic Dermatitis in Spain

OBJECTIVES: Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by itchy, painful, and dry skin, with a prevalence of around 6.43% in adolescent patients in Spain. This analysis aimed to evaluate the cost-effectiveness of abrocitinib (100 and 200 mg) versus dupilumab in the treatment of adolescent patients (12-17 years) with severe AD who are candidates for systemic treatments, from the Spanish National Health System (NHS) perspective.

METHODS: A hybrid model consisting of a decision-tree (52-weeks) followed by a Markov model (6-month cycles) was developed. In the decision-tree, patients started treatment, and response (75% reduction in baseline Eczema Area and Severity Index score, EASI-75) and discontinuation rates were assessed at weeks 16 and 52. In the Markov model (remainder of the 5-year time horizon), three health states were considered: maintenance with active treatment, subsequent treatment (in case of discontinuation or loss of response), and death. Efficacy and utility data were obtained from the literature. Unit costs (€, 2023 values) for drug acquisition and administration, adverse events, testing, medical visits, hospitalisations, and subsequent treatment, were obtained from local sources. The analysis was stated as incremental cost per quality-adjusted life years (QALYs) gained. To evaluate the robustness of the model, deterministic and probabilistic sensitivity analyses (PSA) were carried out.

RESULTS: Abrocitinib (100 and 200 mg) was dominant (lower incremental costs and higher incremental benefit) versus dupilumab, generating a QALYs gain of 0.02 and 0.10 per-patient with cost savings of €8,589, and €9,520, respectively. Sensitivity analyses confirmed the robustness of the model. According to the PSA, abrocitinib was dominant in 70.7% and 80.7% of the simulations for the 100 mg and 200 mg presentation compared to dupilumab, respectively.

CONCLUSIONS: From the Spanish NHS perspective, abrocitinib is a dominant alternative versus dupilumab in the treatment of adolescents with severe AD.