Ong Clarence, Briones Jamaica, Lim Zhi Zhen, Chandran Nisha Suyien, Lee Haur Yueh, Li Benny Kaihui, Yew Yik Weng, Wee Hwee-Lin
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore.
National University Hospital, Singapore, Singapore.
Pharmacoecon Open. 2024 Nov;8(6):809-822. doi: 10.1007/s41669-024-00507-5. Epub 2024 Jul 13.
Atopic dermatitis (AD) affects both adults and children, impacting their quality of life and productivity; however, traditional systemic treatments such as cyclosporine have limitations. Emerging novel systemic interventions, including monoclonal antibodies and Janus kinase (JAK) inhibitors, have been shown to improve patient outcomes.
This study evaluates the cost-effectiveness of novel systemic interventions for moderate-to-severe AD in adults compared with the best supportive care (BSC) in Singapore.
The economic evaluation used a hybrid model consisting of a decision tree and Markov model. Treatment responses at 16 weeks were based on a network meta-analysis that was developed specifically for this study. Long-term response, discontinuation rates, episodes of flares and treatment-emergent adverse events were obtained from key dupilumab, abrocitinib, baricitinib and upadacitinib trials. The study had a 5-year time horizon and considered the healthcare payer's perspective. Sensitivity and scenario analyses were performed as well.
Baricitinib 4 mg and 2 mg have the lowest incremental cost-effectiveness ratios, at Singapore dollars (S$) 60,730/quality-adjusted life-year (QALY) and S$66,842/QALY, respectively. Upadacitinib 30 mg offers the highest incremental QALY gain, while baricitinib 2 mg offers the least. The cost of the intervention drugs accounted for the highest proportion of the overall expenses (68-93%) for those in the maintenance state. Other influential factors within the model included (1) the incremental utility derived from intervention response; (2) the probability of achieving Eczema Area and Severity Index 75 (EASI-75) with BSC; and (3) the relative risk of achieving EASI-75 with the interventions. In a scenario where the cost of all drugs is matched to the lowest-priced drug, the top three cost-effectiveness interventions are dupilumab, upadacitinib 30 mg and abrocitinib 200 mg, respectively.
The interventions are not found to be cost-effective at their existing prices when compared with BSC. Ideally, a composite score of treatment success and quality-of-life scores ought to be included, but such data were unavailable. Future research should consider conditional discontinuation data and long-term outcomes when such data become accessible.
特应性皮炎（AD）影响成人和儿童，对他们的生活质量和生产力产生影响；然而，传统的全身治疗方法如环孢素存在局限性。包括单克隆抗体和Janus激酶（JAK）抑制剂在内的新型全身干预措施已被证明可改善患者预后。
本研究评估了成人中重度AD新型全身干预措施与新加坡最佳支持治疗（BSC）相比的成本效益。
经济评估采用了由决策树和马尔可夫模型组成的混合模型。16周时的治疗反应基于专门为本研究开发的网络荟萃分析。长期反应、停药率、皮疹发作次数和治疗中出现的不良事件来自关键的度普利尤单抗、阿布昔替尼、巴瑞替尼和乌帕替尼试验。该研究有5年的时间跨度，并考虑了医疗保健支付者的观点。还进行了敏感性和情景分析。
4毫克和2毫克的巴瑞替尼的增量成本效益比最低，分别为60,730新加坡元/质量调整生命年（QALY）和66,842新加坡元/QALY。30毫克的乌帕替尼提供的增量QALY增益最高，而2毫克的巴瑞替尼提供的最少。干预药物的成本在维持状态患者的总费用中占比最高（68 - 93%）。模型中的其他影响因素包括：（1）干预反应带来的增量效用；（2）BSC达到湿疹面积和严重程度指数75（EASI - 75）的概率；（3）干预措施达到EASI - 75的相对风险。在所有药物成本与最低价药物匹配的情景下，成本效益最高的前三项干预措施分别是度普利尤单抗、30毫克的乌帕替尼和200毫克的阿布昔替尼。
与BSC相比，现价格下这些干预措施未被发现具有成本效益。理想情况下，应纳入治疗成功和生活质量评分的综合评分，但此类数据不可用。当此类数据可用时，未来研究应考虑有条件停药数据和长期结果。
