Shi Yin, Zhou Yanwu, Li Shuishi, Guan Haijing, Liu Shao
Department of Pharmacy, Xiangya Hospital Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, Hunan, China.
J Med Econ. 2024 Jan-Dec;27(1):1180-1189. doi: 10.1080/13696998.2024.2403940. Epub 2024 Sep 18.
Biologics and JAK inhibitors were the most effective innovative systemic treatments for moderate-to-severe atopic dermatitis (AD). However, their cost-effectiveness in China remains unclear. This study aims to compare both the short- and long-term cost-effectiveness of abrocitinib and dupilumab in adults with moderate-to-severe AD from the perspective of the Chinese healthcare system.
A hybrid decision tree and Markov model were developed to simulate the costs and health outcomes of interventions on both short-term and long-term horizons. Short- and long-term horizons were employed to reflect the 26-week induction treatment and model the extended 10-year maintenance treatment period, respectively. The cost-effectiveness of strategies was measured by incremental cost-effectiveness ratios (ICERs), which were then compared with the willingness-to-pay threshold (WTP) that was equivalent to the gross domestic product (GDP) per capita of China in 2023 ($12,681 [€11,679.26]). One-way and probabilistic sensitivity analyses were conducted to validate the robustness of the model.
Over the short-term horizon, the QALYs (quality-adjusted life years) gained were 0.43 for the abrocitinib group and 0.42 for the dupilumab group, with the costs being $2,716.01 (€2,501.46) and $3,940.33 (€3,629.06), respectively. Over the long-time horizon, abrocitinib therapy yields higher QALYs (6.60 versus 6.53) and incurs a lower cost ($22,765.15 [€20,966.81] versus $30,683.38 [€28,259.54]) compared to dupilumab. The probability of abrocitinib being cost-effective was nearly 100% under the current WTP. Both short- and long-term results showed that abrocitinib was more effective and less costly than dupilumab, making abrocitinib the dominant option.
Abrocitinib was dominant compared to dupilumab both over the short- and long-term horizon for moderate-to-severe AD in China. Future research incorporating real-world evidence and long-term efficacy outcomes could further refine these economic evaluations.
生物制剂和JAK抑制剂是治疗中度至重度特应性皮炎（AD）最有效的创新型全身治疗方法。然而，它们在中国的成本效益仍不明确。本研究旨在从中方医疗体系的角度比较阿布昔替尼和度普利尤单抗在中度至重度AD成人患者中的短期和长期成本效益。
构建了一个混合决策树和马尔可夫模型，以模拟干预措施在短期和长期的成本及健康结果。短期和长期分别用于反映26周的诱导治疗以及模拟长达10年的维持治疗期。策略的成本效益通过增量成本效益比（ICER）来衡量，然后将其与支付意愿阈值（WTP）进行比较，该阈值相当于2023年中国的人均国内生产总值（12,681美元[11,679.26欧元]）。进行了单向和概率敏感性分析，以验证模型的稳健性。
在短期内，阿布昔替尼组获得的质量调整生命年（QALY）为0.43，度普利尤单抗组为0.42，成本分别为2,716.01美元（2,501.46欧元）和3,940.33美元（3,629.06欧元）。在长期内，与度普利尤单抗相比，阿布昔替尼治疗产生更高的QALY（6.60对6.53）且成本更低（22,765.15美元[20,966.81欧元]对30,683.38美元[28,259.54欧元]）。在当前的支付意愿下，阿布昔替尼具有成本效益的概率接近100%。短期和长期结果均表明，阿布昔替尼比度普利尤单抗更有效且成本更低，使阿布昔替尼成为主要选择。
在中国，对于中度至重度AD，无论短期还是长期，阿布昔替尼与度普利尤单抗相比都具有优势。纳入真实世界证据和长期疗效结果的未来研究可能会进一步完善这些经济评估。
