A Cost-Effectiveness Analysis of Abrocitinib vs. Upadacitinib and Baricitinib for the Treatment of Moderate-to-Severe Atopic Dermatitis
Author(s)
Boglarka Mikudina, MSc1, Gulraj S. Matharu, MD, PhD1, Karim Amer, MD, MBA1, Iulia Dunnett, MSc2, Fionn Woodcock, MSc2, Zenas Z. Yiu, MBChB MRCP (Dermatology) MSc PhD3.
1Pfizer Ltd, Walton Oaks, Surrey, United Kingdom, 2Source Health Economics, London, United Kingdom, 3The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom.
1Pfizer Ltd, Walton Oaks, Surrey, United Kingdom, 2Source Health Economics, London, United Kingdom, 3The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom.
OBJECTIVES: Janus Kinase inhibitors (JAKi) are advanced oral systemic therapies recommended for treating moderate-to-severe atopic dermatitis (AD) by NICE (National Institute of Health and Care Excellence). However, no direct cost-effectiveness analyses exist to guide clinical decision making. We evaluated the cost-effectiveness of JAKi (abrocitinib, upadacitinib, and baricitinib) in moderate-to-severe AD in England, including the impact of varying drug discounts.
METHODS: A hybrid economic model captured short-term outcomes (1-year decision tree) before patients transitioned to a three-state Markov model (lifetime horizon; 1-year cycle length). Patients not achieving a response (>75% improvement in Eczema Area and Severity Index [EASI-75]) by Week 16 stopped treatment. Response rates and relative efficacy estimates were obtained from peer-reviewed publications. Where two doses of a treatment were licensed, patients received the lower dose, with up-titration by Week 12 in non-responders. Other assumptions aligned with NICE TA814. Outputs included cost per response (EASI-75) at Week 16, and incremental cost-effectiveness ratios (ICER) expressed as cost per quality-adjusted life year (QALY). Two-way sensitivity analyses applied 0-95% discounts to each JAKi list price.
RESULTS: Costs per response at Week 16 were £5,035 for abrocitinib (71.0% response probability), £5,396 for upadacitinib (76.1%), and £7,609 for baricitinib (42.3%). ICERs for abrocitinib were £422,933/QALY (-0.04 QALYs, -£16,243, cost-effective, South-West quadrant) versus upadacitinib, and £69,324/QALY (+0.26 QALYs, +£18,222, not cost-effective, North-East quadrant) versus baricitinib. Abrocitinib was cost-effective versus upadacitinib when both drugs were discounted by ≤90%, and versus baricitinib with a ≥63.1% discount (willingness-to-pay threshold: £20,000/QALY).
CONCLUSIONS: Abrocitinib had the lowest cost per response amongst JAKi. Even with discounts, abrocitinib remained cost-effective versus upadacitinib, as most patients transitioned to the higher, more expensive dose of upadacitinib. Abrocitinib was cost-effective versus baricitinib with >63.1% discount. This was related to more patients failing baricitinib treatment (57.7% versus 29.0%) and switching to cheaper best supportive care.
METHODS: A hybrid economic model captured short-term outcomes (1-year decision tree) before patients transitioned to a three-state Markov model (lifetime horizon; 1-year cycle length). Patients not achieving a response (>75% improvement in Eczema Area and Severity Index [EASI-75]) by Week 16 stopped treatment. Response rates and relative efficacy estimates were obtained from peer-reviewed publications. Where two doses of a treatment were licensed, patients received the lower dose, with up-titration by Week 12 in non-responders. Other assumptions aligned with NICE TA814. Outputs included cost per response (EASI-75) at Week 16, and incremental cost-effectiveness ratios (ICER) expressed as cost per quality-adjusted life year (QALY). Two-way sensitivity analyses applied 0-95% discounts to each JAKi list price.
RESULTS: Costs per response at Week 16 were £5,035 for abrocitinib (71.0% response probability), £5,396 for upadacitinib (76.1%), and £7,609 for baricitinib (42.3%). ICERs for abrocitinib were £422,933/QALY (-0.04 QALYs, -£16,243, cost-effective, South-West quadrant) versus upadacitinib, and £69,324/QALY (+0.26 QALYs, +£18,222, not cost-effective, North-East quadrant) versus baricitinib. Abrocitinib was cost-effective versus upadacitinib when both drugs were discounted by ≤90%, and versus baricitinib with a ≥63.1% discount (willingness-to-pay threshold: £20,000/QALY).
CONCLUSIONS: Abrocitinib had the lowest cost per response amongst JAKi. Even with discounts, abrocitinib remained cost-effective versus upadacitinib, as most patients transitioned to the higher, more expensive dose of upadacitinib. Abrocitinib was cost-effective versus baricitinib with >63.1% discount. This was related to more patients failing baricitinib treatment (57.7% versus 29.0%) and switching to cheaper best supportive care.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE9
Topic
Economic Evaluation
Topic Subcategory
Thresholds & Opportunity Cost
Disease
Sensory System Disorders (Ear, Eye, Dental, Skin)