OBJECTIVES: Systemic therapy for management of moderate-to-severe atopic dermatitis (AD) in patients with inadequate response (IR) to topical treatments has been limited to dupilumab. Given the expected launch of baricitinib, an oral Janus kinase inhibitor indicated for this population, the budget impact of adding baricitinib to a commercial managed-care formulary for treatment of moderate-to-severe AD was estimated from a US payer perspective.

METHODS: A budget impact analysis was done using a comparative cost determination framework and a 5-year time horizon. Starting with a hypothetical commercial plan of one million lives, the model estimated the number of baricitinib-eligible patients by disease severity using AD prevalence, topical treatment use, and IR to topical treatments. Baricitinib was assumed to draw market share from dupilumab, with uptake ranging from 2% to 12%, 1% to 5%, and 2% to 11% in the moderate, severe, and moderate-to-severe AD populations, respectively. Treatment costs excluded rebates and cost-sharing and were from published wholesale acquisition costs. Dosing, administration, and monitoring requirements were from product prescribing information. Unit costs were from publicly available fee schedules. One-way sensitivity analyses (OWSA) were performed by varying all parameters by 20%.

RESULTS: The net budget impact over 5-years in the moderate AD population was -$4,393,706 (-3.05%) with a -$0.07 per member per month (PMPM). In the severe AD population, the net budget impact was -$372,200 (-1.15%) with a PMPM of -$0.01. In the moderate-to-severe AD population, the net budget impact was -$4,719,710 (-2.68%) with a PMPM of -$0.08. OWSA results were consistent with the base case, with results most sensitive to changes in epidemiological inputs, baricitinib market shares, and monitoring costs.

CONCLUSIONS: Adding baricitinib to a formulary would result in cost-savings across all three disease severities, with the greatest relative cost-savings in the moderate AD population, given the lower annual cost compared to dupilumab.