OBJECTIVES

Dupilumab has been approved for the treatment of moderate to severe Atopic Dermatitis (AD), Severe and Refractory Asthma and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP).

Type 2 inflammation is the common driver for all these diseases that often coexist in the same patient. The objective of this analysis was to estimate the cross-coverage effect of dupilumab in treating Type 2 inflammatory diseases compared to other therapeutic alternatives on the Italian National Health Service expenditure.

METHODS

The analysis focused on the crowding-out effect of dupilumab in AD and CRSwNP patients with comorbid asthma and for asthma patients with comorbid CRSwNP on alternative treatments (omalizumab, mepolizumab, benralizumab for Ashtma; oral systemic corticosteroids and Endoscopic Sinus Surgery - ESS for CRSwNP). The analysis was run on a three-years’ time-horizon budget impact model. Input data include data on target population, actual costs of medicines and ESS. Three alternative scenarios for market penetration (15%-30%-100%) were assumed.

RESULTS

Avoidable direct health annual costs due to the cross-coverage of dupilumab in (i) AD treated patients with comorbid Asthma ranged from 0.46 to 3.43 million euros; (ii) CRSwNP treated patients with comorbid Asthma ranged from 0.08 to 0.88 million euros; (iii) Asthma treated patients with comorbid CRSwNP ranged from 0.41 to 4.05 million euros respectively. The total economic benefit ranges from 0.95 to 8.36 million euros.

CONCLUSIONS

The economic advantages of disease cross-coverage are very important for payers, that always look at sustainable solutions to optimize the use of scarce resources. The analysis did not incorporate avoided/incremental events due to a possible better/worse risk-benefit profile of dupilumab vs alternative treatments, since there is not direct comparison between dupilumab and the competitors. Nonetheless, the analysis relies on the best available evidence for Italy to shed light on a topic which has not been sufficiently investigated to date.