OBJECTIVES:

Atopic dermatitis (AD) is a chronic, inflammatory skin disease associated with a significant burden. Abrocitinib, an oral, once-daily Janus kinase-1 selective inhibitor has demonstrated clinical efficacy in patients with moderate-to-severe AD, but evidence of its cost-effectiveness remains limited.

We aimed to evaluate lifetime cost-effectiveness from the Canadian healthcare system perspective of abrocitinib 100 and 200mg plus standard of care (SoC)—consisting of background topical therapy—versus currently available treatments in patients with moderate-to-severe AD.

METHODS:

We developed a pharmacoeconomic model consisting of a decision tree and Markov model. Patients were assessed for response (defined as a 75% reduction from baseline using the Eczema Area and Severity Index) after 16 and 52 weeks. Those still responsive at 52 weeks continued treatment until loss of response or discontinuation, whereupon they advanced to subsequent treatment. Comparators included dupilumab and immunosuppressants (cyclosporine and methotrexate) (each plus SoC), and SoC alone. Efficacy inputs were derived from a network meta-analysis and matching-adjusted indirect comparison, while medical resource utilization, costs and utilities were derived from publicly available sources or expert opinion. Analyses were conducted by implementing 2,500 model iterations, each one drawing the values of key model inputs from predefined probability distributions.

RESULTS:

At mean estimated incremental costs and quality-adjusted life years (QALYs), abrocitinib 200mg and 100mg dominated dupilumab 200/300mg. In addition, incremental cost-effectiveness ratios (ICERs) calculated from mean incremental costs and QALYs for abrocitinib 200mg (100mg) were $63,685/QALY ($56,477/QALY), $64,319/QALY ($57,274/QALY), and $71,690/QALY ($66,058/QALY) versus cyclosporine 50mg, methotrexate 2.5mg and SoC, respectively. Scenario analyses accounting for indirect costs produce significantly lower ICERs due to considerable levels of work impairment attributable to poorly controlled AD.

CONCLUSIONS:

Both abrocitinib 100mg and 200mg are highly likely to represent a cost-effective alternative to dupilumab for the treatment of patients with moderate-to-severe AD and, given willingness-to-pay exceeding $71,690QALY, compare favorably with immunosuppressants and SoC.