Pharmacoeconomic Analysis of Abrocitinib in Patients with Severe Atopic Dermatitis Versus Systemic Treatments in Spain
Author(s)
Campos Domínguez M1, Herranz Pinto P2, Romero Jiménez RM1, Aceituno Mata S3, Bellmunt A4, Prades M5, Arumi D6, Hernández-Martín I6, Herrera-Lasso V6, Llevat N6, Peral C6, De Lossada Juste A7, Rebollo F6
1Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain, 2Hospital Universitario La Paz, Madrid, Madrid, Spain, 3Outcomes'10, Castellón de la Plana, CS, Spain, 4Outcomes'10 S.L., Castellón, CS, Spain, 5Outcomes'10 S.L., Castellón de la Plana, Castellón, Spain, 6Pfizer SLU, Alcobendas, Madrid, Spain, 7Pfizer S.L.U., ALCOBENDAS, M, Spain
Presentation Documents
OBJECTIVES: To evaluate the cost-effectiveness of abrocitinib (200mg) versus dupilumab (300mg), tralokinumab (300mg), baricitinib (2mg/4mg) and upadacitinib (15mg/30mg) in the treatment of adult patients with severe atopic dermatitis (AD) who are candidates for systemic treatments, from the Spanish National Health System (NHS) perspective.
METHODS: A hybrid model was composed of a decision-tree (52-weeks) followed by a Markov model (6-month cycles) to estimate costs, quality-adjusted life-years (QALYs), total years in response and incremental cost-per-QALY gained (willingness-to-pay threshold: €25,000/QALY). In the decision-tree, patients started treatment. and response (75% reduction in baseline Eczema Area and Severity Index score, EASI-75) and discontinuation rates were assessed at 16 and 52 weeks. In the Markov model (remainder of the 5-year time horizon), three health states were considered: maintenance with active treatment, subsequent treatment (discontinuation or loss of response), and death. Efficacy and utility data were obtained from the literature. Unit costs (€, 2022 values) for drug acquisition and administration, adverse events, testing, medical visits, hospitalizations, and subsequent treatment, were obtained from local sources. Additionally, cost per Number-Needed-to-Treat (NNT) was calculated for abrocitinib and dupilumab based on a post-hoc analysis (12-weeks EASI-75 responders).
RESULTS: Abrocitinib was dominant versus all comparators (dupilumab 300mg, tralokinumab 300mg, baricitinib 2mg, baricitinib 4mg, upadacitinib 15mg and upadacitinib 30mg), generating a QALYs gain of 0.27, 0.35, 0.37, 0.27, 0.22 and 0.01 with per-person cost-savings of €13,984, €15,503, €7,910, €3,867, €6,023, and €30,839, respectively. Abrocitinib led to an increase in years in response versus comparators (1.07, 1.40, 1.54, 1.08, 0.92, 0.05, respectively). Sensitivity analyses confirmed the robustness of the model. NNT was 1.5 for abrocitinib 200mg (cost-per-NNT: €17,479) and 2.3 for dupilumab (cost-per-NNT: €36,266) versus placebo; NNT was 4.4 for abrocitinib 200mg versus dupilumab (abrocitinib was dominant).
CONCLUSIONS: From the Spanish NHS perspective, abrocitinib is a dominant alternative versus currently available therapies for adults with severe AD.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
EE408
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Drugs, Sensory System Disorders (Ear, Eye, Dental, Skin), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)