OBJECTIVES: To evaluate cost-effectiveness of abrocitinib versus dupilumab for treating moderate-to-severe atopic dermatitis in Chinese adults from the societal perspective.

METHODS: A decision tree combined with a Markov model was developed to estimate 5-year costs and quality-adjusted life-years (QALYs) for patients with moderate or severe atopic dermatitis. The Markov model was divided into three states: maintenance, best-supportive care, and death. Patients with Eczema Area and Severity Index (EASI) scores ≥75 or EASI scores ≥90 were defined as the responders and stayed in the maintenance state. The model assumed no increased mortality risk associated with atopic dermatitis compared to the general population. The transition probabilities were derived from the JADE and SOLO-CONTINUE clinical studies, which included the Asian population. Direct medical costs, indirect costs, and utility values were derived from the published literature or public databases. One-way sensitivity and probabilistic sensitivity analyses were also conducted to examine the impact of uncertainty of the parameters.

RESULTS: For patients with moderate atopic dermatitis, compared to dupilumab, abrocitinib led to a gain of 0.14 QALYs at additional cost of ¥39,070, resulting in an ICER of ¥275,626 per QALY gained. For patients with severe atopic dermatitis, abrocitinib showed an incremental gain of 0.23 QALYs at additional cost of ¥30,367, resulting in an ICER of ¥131,308/QALY. Abrocitinib exhibited a higher number of response-years compared to dupilumab over five years (1.77 vs. 1.18). Sensitivity analyses indicated that the model outputs were most sensitive to the utility of EASI-90 state and drug prices. At a willingness-to-pay threshold of ¥257,094/QALY (3 times of GDP-per-capita in China), abrocitinib was more likely to be cost-effective for severe patients than moderate patients.

CONCLUSIONS: Abrocitinib offers more durable clinical efficacy and quality of life gains for patients with moderate-to-severe atopic dermatitis compared to dupilumab in China and is considered cost-effective for severe patients.