Cost-Effectiveness Analysis of Abrocitinib Compared with Other Systemic Treatments for Severe Atopic Dermatitis in Spain.

IF 2 Q2 ECONOMICS
PharmacoEconomics Open Pub Date : 2024-03-01 Epub Date: 2024-01-18 DOI:10.1007/s41669-023-00459-2
Rosa María Romero Jiménez, Pedro Herranz Pinto, Minia Campos Domínguez, Susana Aceituno Mata, Alba Bellmunt, Miriam Prades, Daniel Arumi, Irene Hernández-Martín, Valeria Herrera-Lasso, Noelia Llevat, Alfonso De Lossada Juste, Francisco José Rebollo Laserna
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引用次数: 0

Abstract

Introduction: Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by itchy, painful, and dry skin. Despite the great number of available therapies, economic evaluations are still needed to provide evidence on their cost efficiency. This research aimed to evaluate the cost effectiveness of the Janus kinase (JAK) inhibitor abrocitinib (200 mg) compared with dupilumab (300 mg), tralokinumab (300 mg), baricitinib (2 and 4 mg), and upadacitinib (15 and 30 mg) for the treatment of patients with severe AD from the Spanish National Health System (NHS) perspective.

Methods: A hybrid model consisting of a decision tree linked to a Markov model was developed to estimate costs, quality-adjusted life-years (QALYs), total years in response and incremental cost-per-QALY gained (willingness-to-pay [WTP] threshold: €25,000/QALY). Adults with severe AD entered the decision tree and response (75% reduction in baseline Eczema Area and Severity Index score, EASI-75) was considered at 16 and 52 weeks. After this time, patients entered the Markov model (remainder of the 10-year time horizon), which consisted of three health states: maintenance with active therapy, subsequent treatment, or death. All costs were presented in 2022 euros (€). Additionally, cost per number-needed-to-treat (NNT) was calculated for abrocitinib and dupilumab based on a head-to-head post-hoc analysis.

Results: Abrocitinib 200 mg was dominant (i.e., lower incremental costs and higher incremental benefit) compared with all studied alternatives (dupilumab 300 mg, tralokinumab 300 mg, baricitinib 2 and 4 mg, upadacitinib 15 and 30 mg) with a QALYs gain of 0.49, 0.60, 0.64, 0.43, 0.45, and 0.08, respectively, and per-person costs savings of €22,097, €24,140, €14,825, €7,116, €12,805, and €45,189, respectively. Considering the WTP threshold, abrocitinib was dominant or cost effective compared with all alternatives for most simulations. Additionally, abrocitinib was dominant compared with all alternatives when evaluating the cost effectiveness over a 5-year time horizon. NNT showed that abrocitinib was dominant versus dupilumab.

Conclusions: The results of the study show that abrocitinib is a cost-effective therapy compared with other JAK inhibitors and biological therapies from the Spanish NHS perspective.

在西班牙,阿昔替尼与其他治疗严重特应性皮炎的系统疗法相比的成本效益分析。
简介特应性皮炎(AD)是一种以皮肤瘙痒、疼痛和干燥为特征的慢性炎症性皮肤病。尽管现有的治疗方法很多,但仍需要经济评估来证明其成本效益。本研究旨在从西班牙国家卫生系统(NHS)的角度,评估Janus激酶(JAK)抑制剂阿罗西替尼(200毫克)与dupilumab(300毫克)、tralokinumab(300毫克)、baricitinib(2毫克和4毫克)和upadacitinib(15毫克和30毫克)相比,治疗严重AD患者的成本效益:开发了一个由决策树和马尔可夫模型组成的混合模型,用于估算成本、质量调整生命年(QALY)、总应答年数和每QALY增量成本(支付意愿阈值:25,000欧元/QALY)。重度 AD 成人患者进入决策树,并在 16 周和 52 周时考虑应答情况(基线湿疹面积和严重程度指数 EASI-75 评分降低 75%)。此后,患者进入马尔可夫模型(10 年时间跨度的剩余部分),其中包括三种健康状态:积极治疗维持、后续治疗或死亡。所有成本均以 2022 欧元(€)为单位。此外,基于头对头事后分析,还计算了阿罗西替尼和杜比单抗的单位治疗人数成本(NNT):结果:阿昔替尼 200 毫克占优势(即结果:阿昔替尼 200 毫克与所有研究的替代品(杜匹单抗 300 毫克、曲妥珠单抗 300 毫克、巴利昔替尼 2 毫克和 4 毫克、达帕替尼 15 毫克和 30 毫克)相比具有优势(即增量成本更低、增量收益更高),其 QALYs 收益分别为 0.49、0.60、0.64、0.43、0.45 和 0.08,人均成本分别为 22,097 欧元、24,140 欧元、14,825 欧元、7,116 欧元、12,805 欧元和 45,189 欧元。考虑到WTP阈值,在大多数模拟中,与所有替代方案相比,阿罗西替尼具有优势或成本效益。此外,在评估 5 年时间跨度的成本效益时,与所有替代方案相比,阿罗西替尼占优势。NNT显示,阿昔替尼与杜比单抗相比具有优势:研究结果表明,从西班牙国家医疗服务体系的角度来看,与其他JAK抑制剂和生物疗法相比,阿罗西替尼是一种具有成本效益的疗法。
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来源期刊
CiteScore
3.50
自引率
0.00%
发文量
64
审稿时长
8 weeks
期刊介绍: PharmacoEconomics - Open focuses on applied research on the economic implications and health outcomes associated with drugs, devices and other healthcare interventions. The journal includes, but is not limited to, the following research areas:Economic analysis of healthcare interventionsHealth outcomes researchCost-of-illness studiesQuality-of-life studiesAdditional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in PharmacoEconomics -Open may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.All manuscripts are subject to peer review by international experts. Letters to the Editor are welcomed and will be considered for publication.
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