Zimmermann Marita, Rind David, Chapman Rick, Kumar Varun, Kahn Sonya, Carlson Josh
J Drugs Dermatol. 2018 Jul 1;17(7):750-756.
Moderate-to-severe atopic dermatitis can be difficult and costly to treat. The long-term health and economic outcomes of a new therapy, dupilumab, have yet to be evaluated. We aimed to identify the cost-effectiveness of dupilumab compared to usual care in moderate-to-severe atopic dermatitis.
We compared dupilumab to usual care with emollients for adults with moderate-to-severe atopic dermatitis inadequately controlled with topical therapy, or for whom topical therapies were medically inadvisable. Subpopulations of moderate and severe patients were examined separately. We used a lifetime Markov model from a US payer perspective with health states categorized by the percent decrease in Eczema Area and Severity Index (EASI) score after a patient began an intervention: at least a 50% decrease (EASI 50), 75% decrease (EASI 75), 90% decrease (EASI 90), or no response.
The expected lifetime cost for patients treated with dupilumab was $509,600, including $267,800 in dupilumab drug costs and $241,800 in other healthcare costs. Average lifetime cost for usual care was $271,500. Dupilumab provided an additional 1.91 quality-adjusted life years (QALYs) over the remaining lifetime of a patient, leading to an incremental cost-effectiveness ratio (ICER) of $124,500. The ICER was lower for patients with severe atopic dermatitis ($95,800) than those with moderate atopic dermatitis ($160,000). Key drivers of the model were utility values for quality-of-life for non-responders, and the price of dupilumab.
This study was limited by data for health outcomes and costs over long time periods, particularly stratified by severity. We estimated that dupilumab improved health outcomes compared to usual care but with additional costs, with an ICER below commonly cited thresholds for cost-effectiveness. Dupilumab was projected to be more cost-effective in patients with severe atopic dermatitis, but even in patients with moderate atopic dermatitis, the ICER remained below the upper range of commonly cited thresholds. J Drugs Dermatol. 2018;17(7):750-756.
中重度特应性皮炎的治疗难度大且成本高。新型疗法度普利尤单抗的长期健康和经济效果尚未得到评估。我们旨在确定度普利尤单抗相较于中重度特应性皮炎常规治疗的成本效益。
对于局部治疗控制不佳或不适合局部治疗的中重度特应性皮炎成人患者，我们将度普利尤单抗与使用润肤剂的常规治疗进行了比较。分别对中度和重度患者亚组进行了检查。我们从美国医保支付方的角度使用了一个终身马尔可夫模型，健康状态按照患者开始干预后湿疹面积和严重程度指数（EASI）评分的下降百分比进行分类：至少下降50%（EASI 50）、75%（EASI 75）、90%（EASI 90）或无反应。
接受度普利尤单抗治疗的患者预期终身成本为509,600美元，其中度普利尤单抗药物成本为267,800美元，其他医疗保健成本为241,800美元。常规治疗的平均终身成本为271,500美元。度普利尤单抗在患者的剩余寿命期间额外提供了1.91个质量调整生命年（QALY），导致增量成本效益比（ICER）为124,500美元。重度特应性皮炎患者的ICER（95,800美元）低于中度特应性皮炎患者（160,000美元）。该模型的关键驱动因素是非反应者的生活质量效用值以及度普利尤单抗的价格。
本研究受到长期健康结果和成本数据的限制，尤其是按严重程度分层的数据。我们估计，与常规治疗相比，度普利尤单抗改善了健康结果，但成本有所增加，ICER低于通常引用的成本效益阈值。预计度普利尤单抗在重度特应性皮炎患者中更具成本效益，但即使在中度特应性皮炎患者中，ICER仍低于通常引用阈值的上限。《药物皮肤病学杂志》。2018年；17(7):750 - 756。
