COST-EFFECTIVENESS OF LEBRIKIZUMAB VERSUS NEMOLIZUMAB FOR MODERATE-TO-SEVERE ATOPIC DERMATITIS IN THE US: A 10-YEAR ECONOMIC EVALUATION
Author(s)
KEERTHANA R. IYER, BPharm1, Yi Yang, PhD, MD2;
1Department of Pharmacy Administration, University of Mississippi, Oxford, MS, USA, 2University of Mississippi, Department of Pharmacy Administration, University, MS, USA
1Department of Pharmacy Administration, University of Mississippi, Oxford, MS, USA, 2University of Mississippi, Department of Pharmacy Administration, University, MS, USA
OBJECTIVES: To estimate the cost-effectiveness of lebrikizumab compared to nemolizumab for adult patients with moderate-to-severe atopic dermatitis (AD) from a US payer perspective over a 10-year time horizon.
METHODS: A Markov model (16-week cycles) simulated transitions between "Responder," "Non-Responder," and "Discontinued" states. Clinical inputs utilized an indirect comparison of ADhere (lebrikizumab) and ARCADIA (nemolizumab) trials (EASI-75: 69.5% vs. 44.0%). Utilities were derived from published literature, and costs were based on Wholesale Acquisition Costs (WAC). The model assumed that patients responding to lebrikizumab would switch to dosing every four weeks (Q4W) and excluded background death rates because atopic dermatitis is not a fatal condition. Both deterministic and probabilistic sensitivity analyses (PSA; 10,000 simulations) were conducted to assess parameter uncertainty. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY).
RESULTS: Base-case 10-year costs were $271,598 (lebrikizumab) and $197,243 (nemolizumab). Lebrikizumab generated 6.51 QALYs versus 6.12, yielding an ICER of $188,784/QALY. PSA results indicated low cost-effectiveness probabilities at standard thresholds: 10.5% at a willingness-to-pay (WTP) of $100,000/QALY and ~27% at $150,000/QALY. Results were most sensitive to lebrikizumab costs and responder utilities. Achieving cost-effectiveness (less than $150,000/QALY) required responder utility greater than 0.817 or a ~7% reduction in the price of lebrikizumab.
CONCLUSIONS: Lebrikizumab provides greater health benefits than nemolizumab but exceeds US cost-effectiveness thresholds at current prices. PSA confirmed the robustness of these results, demonstrating less than 30% probability of cost-effectiveness at $150,000/QALY. Reductions in lebrikizumab pricing or real-world evidence confirming superior quality-of-life benefits are likely required to establish economic value. A key limitation is the lack of head-to-head trial data, necessitating the use of indirect comparisons.
METHODS: A Markov model (16-week cycles) simulated transitions between "Responder," "Non-Responder," and "Discontinued" states. Clinical inputs utilized an indirect comparison of ADhere (lebrikizumab) and ARCADIA (nemolizumab) trials (EASI-75: 69.5% vs. 44.0%). Utilities were derived from published literature, and costs were based on Wholesale Acquisition Costs (WAC). The model assumed that patients responding to lebrikizumab would switch to dosing every four weeks (Q4W) and excluded background death rates because atopic dermatitis is not a fatal condition. Both deterministic and probabilistic sensitivity analyses (PSA; 10,000 simulations) were conducted to assess parameter uncertainty. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY).
RESULTS: Base-case 10-year costs were $271,598 (lebrikizumab) and $197,243 (nemolizumab). Lebrikizumab generated 6.51 QALYs versus 6.12, yielding an ICER of $188,784/QALY. PSA results indicated low cost-effectiveness probabilities at standard thresholds: 10.5% at a willingness-to-pay (WTP) of $100,000/QALY and ~27% at $150,000/QALY. Results were most sensitive to lebrikizumab costs and responder utilities. Achieving cost-effectiveness (less than $150,000/QALY) required responder utility greater than 0.817 or a ~7% reduction in the price of lebrikizumab.
CONCLUSIONS: Lebrikizumab provides greater health benefits than nemolizumab but exceeds US cost-effectiveness thresholds at current prices. PSA confirmed the robustness of these results, demonstrating less than 30% probability of cost-effectiveness at $150,000/QALY. Reductions in lebrikizumab pricing or real-world evidence confirming superior quality-of-life benefits are likely required to establish economic value. A key limitation is the lack of head-to-head trial data, necessitating the use of indirect comparisons.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE101
Topic
Economic Evaluation
Disease
SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), STA: Biologics & Biosimilars