Cost-Effectiveness Analysis of Lebrikizumab vs. Alternative Biologics in Adults and Adolescents With Moderate-to-Severe Atopic Dermatitis in the UK
Author(s)
Warda Tahir, MSc1, Vanessa Buchanan, MSc, PhD1, Jonathan Silverberg, MD, PhD, MPH2, Michael Ardern-Jones, BSc, MBBS, DPhil, FRCP3, Laia Solé-Feu, MSc4, Buelent Akmaz, MA, PhD4, Helena Agell-Gimeno, BSc4, Anthony Bewley, BA (hons), MB ChB, FRCP5.
1Cogentia Healthcare Consulting, Cambridge, United Kingdom, 2George Washington University, Washington, DC, USA, 3University Hospital Southampton, Southampton, United Kingdom, 4Almirall S.A., Barcelona, Spain, 5Barts Health NHS Trust & Queen Mary University, London, United Kingdom.
1Cogentia Healthcare Consulting, Cambridge, United Kingdom, 2George Washington University, Washington, DC, USA, 3University Hospital Southampton, Southampton, United Kingdom, 4Almirall S.A., Barcelona, Spain, 5Barts Health NHS Trust & Queen Mary University, London, United Kingdom.
OBJECTIVES: Lebrikizumab is a new biologic indicated for treating moderate-to-severe atopic dermatitis (AD) in adults and adolescents who are candidates for systemic therapy. Biologics (lebrikizumab, dupilumab, tralokinumab) and JAK inhibitors are recommended by NICE and the Scottish Medicines Consortium for treating moderate-to-severe AD in patients that are not suitable for or have not responded to at least one systemic immunosuppressant. The objective was to determine the cost-effectiveness of lebrikizumab against alternative biologics for treating moderate-to-severe AD.
METHODS: A de novo model was developed to compare the cost-effectiveness of lebrikizumab monotherapy versus other biologics reimbursed for the treatment of moderate-to-severe AD in the UK. The model structure comprised a 1-year decision tree to account for the induction (16 weeks) and initial response period (36 weeks), leading into a lifetime Markov model to account for the long-term maintenance of response. Clinical efficacy was defined as the proportion of patients achieving a composite response of EASI-50 + DLQI≥4-point reduction at week 16. Relative efficacy versus comparators was informed by a network meta-analysis (NMA) of EASI-75 as a proxy endpoint. Other clinical parameters of interest were informed by Phase 3 trial data from each respective treatment. Health state utility values were informed by EQ-5D data from the Phase 3 lebrikizumab ADvocate trials. Resource use was informed by previously published NICE appraisals.
RESULTS: Lebrikizumab monotherapy generated 0.07 incremental QALYs and £9,942 incremental costs (at published list-prices) compared to an alternative biologics ‘basket’. The most influential parameters were long-term discontinuation rates followed by NMA efficacy effects.
CONCLUSIONS: Commercial arrangements add further value to real world incremental costs and lebrikizumab is considered cost-effective against alternative biologics and was recommended for reimbursement by UK HTA agencies in AD patients that are not suitable for or have not responded to at least one systemic immunosuppressant. Lebrikizumab generates more QALYs than comparator biologics.
METHODS: A de novo model was developed to compare the cost-effectiveness of lebrikizumab monotherapy versus other biologics reimbursed for the treatment of moderate-to-severe AD in the UK. The model structure comprised a 1-year decision tree to account for the induction (16 weeks) and initial response period (36 weeks), leading into a lifetime Markov model to account for the long-term maintenance of response. Clinical efficacy was defined as the proportion of patients achieving a composite response of EASI-50 + DLQI≥4-point reduction at week 16. Relative efficacy versus comparators was informed by a network meta-analysis (NMA) of EASI-75 as a proxy endpoint. Other clinical parameters of interest were informed by Phase 3 trial data from each respective treatment. Health state utility values were informed by EQ-5D data from the Phase 3 lebrikizumab ADvocate trials. Resource use was informed by previously published NICE appraisals.
RESULTS: Lebrikizumab monotherapy generated 0.07 incremental QALYs and £9,942 incremental costs (at published list-prices) compared to an alternative biologics ‘basket’. The most influential parameters were long-term discontinuation rates followed by NMA efficacy effects.
CONCLUSIONS: Commercial arrangements add further value to real world incremental costs and lebrikizumab is considered cost-effective against alternative biologics and was recommended for reimbursement by UK HTA agencies in AD patients that are not suitable for or have not responded to at least one systemic immunosuppressant. Lebrikizumab generates more QALYs than comparator biologics.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE211
Topic
Economic Evaluation
Disease
Biologics & Biosimilars, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)