Using Dupilumab in Line With the England NICE Recommendation (TA534): Impact on the Healthcare Resource Utilization and Non-Medicine Cost

OBJECTIVES: National Institute for Health and Care Excellence (NICE), England, recommends reimbursement of dupilumab (TA534) in patients with moderate-to-severe atopic dermatitis (AD) not responding to treatment with at least one other systemic drug. However, based on a recent market research from England, in real-world practice, dermatologists initiate dupilumab in AD patients after at least two immunosuppressants on average. This study evaluated the resource use and non-medicine costs associated with the initiation of dupilumab after a single immunosuppressant (NICE TA pathway) versus the current practice in England.

METHODS: A health economic impact model was developed to assess the resource use and non-medicine costs associated with treatment monitoring in patients with moderate-to-severe AD initiating dupilumab under the NICE TA pathway versus the current practice. The default set of monitoring requirements and resource use (interactions with practitioners, monitoring time and laboratory tests) in the model reflects local monitoring protocols, published guidelines, and the information available within the summary of product characteristics for the individual treatment regimen. Patient data available from the digital repository of the National Health Service (NHS) was used to run the model. Non-medicine costs include all costs related to treatment monitoring. The two patient pathways’ cohorts were modeled over 5-years.

RESULTS: Over the model’s time horizon of 5-years, initiation of dupilumab as per the NICE recommendation leads to saving 4,800 laboratory tests, 1,400 healthcare practitioner interactions and 36,000 minutes of monitoring time per 100 patients versus current practice. Deviation from NICE recommendation as in the current practice generates an additional non-medicine cost of £1,241/patient (£2,944 for current practice vs £1,703 for NICE TA pathway over the 5-years) due to the deviation from the NICE TA534.

CONCLUSIONS: Implementation of dupilumab in line with the NICE recommendation could result in significant savings for the NHS in terms of healthcare practitioners’ time, interactions, and laboratory tests.