OBJECTIVES: Atopic dermatitis (AD) poses a significant global health burden, affecting a substantial percentage of both pediatric and adult populations . Conventional systemic therapies exhibit limited efficacy and undesirable side effects, emphasizing the urgent need for more effective and economically viable treatment options. This study aims to provide an updated analysis of the cost per response ratio for different systemic medications in monotherapy for moderate-to-severe AD, considering the unique Brazilian healthcare context. Additionally, it explores the number of successfully treated patients across various clinically meaningful endpoints.

METHODS: The study includes biological therapies and JAK inhibitors approved by ANVISA up to January 2024. Efficacy was assessed using EASI and pruritus-NRS scores, aligning with HOME's Core Outcome Set for clinical trials. Costs were calculated based on each specific outcome, considering the factory price with an 18% increment for ICMS. Dosages and costs were derived from prescribing information and network meta-analyses.

RESULTS: Upadacitinib 15 mg emerged as the most cost-effective therapy for achieving EASI-90, providing a substantial cost reduction compared to other medications. All JAK inhibitors demonstrated superior cost per response values for pruritus △NRS ≥ 4 compared to dupilumab. Study limitations: This analysis was limited to the endpoints presented in the meta-analyses and other endpoints might offer different perspectives results.

CONCLUSIONS: This research contributes valuable insights into the cost-effectiveness of systemic therapies for AD in the Brazilian context. Despite not being obligatory, JAK inhibitors showcase notable cost-efficacy, providing an alternative to biological treatments. Decision-makers should leverage cost-effectiveness analyses for informed resource management and prioritize treatments that maximize clinical benefits and minimize costs.