Modeling Early vs. Late Intervention Strategies: The Case of Dupilumab in Children With Severe Atopic Dermatitis
Author(s)
Marine Sivignon, PharmD1, Olfa Doghri, MSc2, Jules TAVI, MSc, PharmD3, Noemie Allali, Msc, PharmD4, Kerry Jane Noonan, MSc5, Anne-Lise VATAIRE, PhD6.
1Pharmacist and Health Economist, Putnam, Lyon, France, 2Putnam, Paris, France, 3Sanofi, Bondy, France, 4Sanofi, Paris, France, 5Sanofi HEVA, Boston, MA, USA, 6Sanofi, Gentilly, France.
1Pharmacist and Health Economist, Putnam, Lyon, France, 2Putnam, Paris, France, 3Sanofi, Bondy, France, 4Sanofi, Paris, France, 5Sanofi HEVA, Boston, MA, USA, 6Sanofi, Gentilly, France.
OBJECTIVES: Atopic Dermatitis (AD) often begins early in life and affects up to 17% of French children and adolescents. Early intervention may improve long-term outcomes. This study used a modeling approach to evaluate the cost-effectiveness of initiating dupilumab at age 6 versus delaying treatment until age 12, in children with severe AD, from the French healthcare system perspective.
METHODS: A cost-effectiveness model previously submitted and accepted by several Health Technology Assessment bodies, including the French Haute Autorité de Santé (HAS), was adapted and methodologically extended to allow comparison of two strategies: (1) dupilumab initiated at age 6 with best supportive care (BSC), and (2) dupilumab initiated at age 12 after BSC alone in children aged 6 to 11. Modeling assumptions validated in previous HAS-reviewed submissions for adolescents and adults were retained when relevant. Clinical inputs were sourced from Phase 3 trials in children and adolescents. Health-related quality of life inputs and resource utilization were derived from real-world studies (ECLAJUNIOR and ECLADO). One-way and probabilistic sensitivity analyses were conducted to test robustness.
RESULTS: Early initiation of dupilumab resulted in a gain of 1.26 QALY (Quality Adjusted Life Years) compared to delayed treatment, at an incremental cost of €24,475, yielding an incremental cost-effectiveness ratio (ICER) of €19,482/QALY. Higher treatment costs (+€29,663) were partially offset by €5,340 savings in disease management. Early treatment also doubled the EASI-75 responder years (5.87 vs 3.80), with a cost of €11,798 per responder year. Deterministic sensitivity analysis showed the ICER was most sensitive to utility parameters for children and caregivers. Probabilistic sensitivity analysis confirmed robustness, with a >99% probability of cost-effectiveness at a €30,000/QALY willingness-to-pay threshold.
CONCLUSIONS: Early initiation of dupilumab at age 6 is a cost-effective strategy for children with severe AD in France, delivering superior clinical and economic outcomes compared to delayed treatment.
METHODS: A cost-effectiveness model previously submitted and accepted by several Health Technology Assessment bodies, including the French Haute Autorité de Santé (HAS), was adapted and methodologically extended to allow comparison of two strategies: (1) dupilumab initiated at age 6 with best supportive care (BSC), and (2) dupilumab initiated at age 12 after BSC alone in children aged 6 to 11. Modeling assumptions validated in previous HAS-reviewed submissions for adolescents and adults were retained when relevant. Clinical inputs were sourced from Phase 3 trials in children and adolescents. Health-related quality of life inputs and resource utilization were derived from real-world studies (ECLAJUNIOR and ECLADO). One-way and probabilistic sensitivity analyses were conducted to test robustness.
RESULTS: Early initiation of dupilumab resulted in a gain of 1.26 QALY (Quality Adjusted Life Years) compared to delayed treatment, at an incremental cost of €24,475, yielding an incremental cost-effectiveness ratio (ICER) of €19,482/QALY. Higher treatment costs (+€29,663) were partially offset by €5,340 savings in disease management. Early treatment also doubled the EASI-75 responder years (5.87 vs 3.80), with a cost of €11,798 per responder year. Deterministic sensitivity analysis showed the ICER was most sensitive to utility parameters for children and caregivers. Probabilistic sensitivity analysis confirmed robustness, with a >99% probability of cost-effectiveness at a €30,000/QALY willingness-to-pay threshold.
CONCLUSIONS: Early initiation of dupilumab at age 6 is a cost-effective strategy for children with severe AD in France, delivering superior clinical and economic outcomes compared to delayed treatment.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE584
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Disease
Pediatrics, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)