Cost-Effectiveness Analysis of Baricitinib Compared to Standard of Care in Improving Symptoms of Alopecia Areata for the Patients in the U.S. From the Healthcare Payer Perspective

OBJECTIVES: This study evaluated the cost-effectiveness of baricitinib 4mg compared to the standard of care (SOC) in treating severe alopecia areata (AA) in patients aged 38 and older from the U.S. healthcare payer perspective. We sought to estimate incremental cost-effectiveness ratios (ICERs) with a focus on quality-adjusted life-years (QALYs) for individuals experiencing significant quality of life impact of severe AA.
METHODS: A Markov model with three health states (severe, mild, remission) was constructed based on the BRAVE-AA2 clinical trial. Patients started in severe state (Severity of Alopecia Tool [SALT] score ≥50) and transitioned between health states monthly over a 5-year horizon. Transition probabilities were derived from clinical trial data and extrapolated to monthly probabilities. Utility values and costs including drug, ambulatory care, and medications were modeled. Costs and outcomes were discounted at 3% per cycle. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were conducted to identify the key drivers of variability and uncertainty in the model.
RESULTS: Baricitinib 4mg produced an ICER of $147,828 per QALY compared to SOC, slightly below the $150,000 willingness-to-pay (WTP) threshold. Treatment with baricitinib increased costs ($299,190 vs. $164,857 for SOC) but also resulted in higher QALYs (3.58 vs. 2.67). Sensitivity analysis identified the utility of severe AA and the monthly cost of baricitinib as the most impactful parameters to the ICER. The PSA result is pending.
CONCLUSIONS: Baricitinib 4mg may be a cost-effective option for treating severe AA, though further characterization of uncertainty around the deterministic ICER is warranted. While it provides more improved outcomes compared to SOC, the results are highly sensitive to factors such as utility values and drug costs, indicating limited robustness. Future research should focus on validating real-world costs, health-related quality of life, and long-term efficacy and safety of the drug.