Treatment with dupilumab in patients with moderate to severe atopic dermatitis (AD) has been shown to improve health outcomes compared with usual care, but with additional costs incurred, with an incremental cost-effectiveness ratio (ICER) below commonly cited thresholds, according to the results of a cost-utility analysis published in the Journal of Drugs in Dermatology.
The investigators sought to compare dupilumab with usual care with emollients in adults with moderate to severe AD that is inadequately controlled with topical treatments or for whom topical treatments are medically not indicated. They examined subpopulations of patients with moderate and severe disease separately. Via use of a lifetime Markov model from a US payer perspective, health status was categorized according to the percentage decrease in Eczema and Severity Index (EASI) score after a patient began an intervention. Scores were classified as follows: ≥50% decrease (EASI 50), ≥75% decrease (EASI 75), ≥90% decrease (EASI 90), or no response.
The predicted lifetime cost for dupilumab-treated patients was $509,600, which included $267,800 in dupilumab drug costs and $241,800 in other healthcare costs. In contrast, the average lifetime cost for usual care was $271,500. Dupilumab therapy provided an additional 1.91 quality-adjusted life-years during the remaining lifetime of a patient, which led to an ICER of $124,500. The ICER was lower among patients with severe AD ($95,800) compared with those with moderate AD ($160,000). Key drivers of the model that were identified included utility values for quality of life for nonresponders and the price of dupilumab.
Limitations of the study include the limited amount of data available on health outcomes, particularly sustained response or discontinuation rates, and costs over the long term.
Although dupilumab was projected to be more cost-effective in patients with severe AD, even in those with moderate disease, the ICER remained below the upper range of commonly cited thresholds.
Zimmermann M, Rind D, Chapman R, Kumar V, Kahn S, Carlson J. Economic evaluation of dupilumab for moderate-to-severe atopic dermatitis: a cost-utility analysis. J Drugs Dermatol. 2018;17(7):750-756.