OBJECTIVES: To perform, from the Mexican NHS perspective, a cost-effectiveness analysis (CEA) of dupilumab in patients ≥6 years old as add-on therapy compared to Standard of Care (cyclosporine [CsA]+Best Supportive Care [BSC] OR BSC alone) for severe atopic dermatitis not adequately controlled under topical therapies or when those therapies are not recommended (base-case).

METHODS: Efficacy data came from pediatric, adolescent, and adult clinical trials. Patients achieving a 75% improvement in the Eczema Area and Severity Index (EASI-75) were considered treatment responders. Direct medical costs were included with a 5% discount rate for costs and effectiveness. Markov model was used to describe natural disease history (lifetime horizon) through 10 health states (mild, moderate, and severe by arm of treatment). Second order Monte Carlo was used to extrapolate results from hypothetic population cohort. Dupilumab patients responders remained on dupilumab permanently. Patients with response to CsA+BSC remained on it during the first year and receive BSC from the 2^nd year on (local CPG recommendations). Patients with response to BSC remain on it permanently. Transitions are monthly based during the 1^st year and annual thereafter. Sensitivity analysis explored different scenarios.

RESULTS: Considering base case analysis, the incremental cost effectiveness ratio per response-year (ICER/ry) gained was $317,882 MXN pesos (dupilumab+BSC vs BSC) and $353,114 MXN pesos (dupilumab+BSC vs CsA+BSC). Based on gross domestic product per capita (GDPpc) willingness to pay threshold (GDPpc ranging between [1-3] is a cost-effective alternative) considering IMF data for Mexico, dupilumab ICER/ry were 1.48 GPDpc (vs BSC) and 1.64 GDPpc (vs CsA+BSC). The exploratory sensitivity analysis with waning effect used by NICE, described ICERs/ry of 0.59 and 0.68 GDPpc, versus BSC & CsA+BSC, respectively.

CONCLUSIONS: Dupilumab is a cost-effective alternative for the treatment of severe atopic dermatitis in patients who failed topical therapies or in which those therapies are not recommended.