Nakahara Takeshi, Noto Shinichi, Matsukawa Miyuki, Takeda Hiroe, Zhang Yilong, Kondo Tomohiro
Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan.
Dermatol Ther (Heidelb). 2024 Nov;14(11):3113-3132. doi: 10.1007/s13555-024-01300-2. Epub 2024 Nov 1.
Difamilast has proven to be an effective treatment for the treatment of atopic dermatitis (AD) in Japan, but its cost-effectiveness remains unknown. Therefore, the objective of the current study was to determine the cost-effectiveness of difamilast 1% compared with delgocitinib 0.5% in Japanese adult patients with moderate-to-severe AD and compared with placebo in Japanese adult patients with all-severity AD from a Japanese public health-care perspective.
The analysis was conducted using a cost-effectiveness model from the Japanese public health-care perspective. This model had four health states ("clear," "mild," "moderate," and "severe") defined according to the Eczema Area and Severity Index score. The time horizon of the analysis was 1 year. Because the analysis period was short, no discount rate was applied. The proportions of patients previously estimated by the anchored matching-adjusted indirect comparison were implemented in the model. The model was further populated with data from the literature. The main model outcomes were quality-adjusted life-years (QALY), costs, and outcomes, including the incremental cost-effectiveness ratio. All prices were stated in JPY at the price level from 2018 April to 2019 March. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the results.
In the base case, the cost-effectiveness of difamilast 1% compared with delgocitinib 0.5% and placebo was JPY 827,054/QALY and JPY 1,518,657/QALY, respectively. The PSA showed that the cost-effectiveness of difamilast 1% compared with delgocitinib 0.5% and placebo had a 66.6% and 99.6% probability of being below the JPY 5 million/QALY threshold, respectively.
The results suggest that difamilast 1% is a more cost-effective treatment option compared with delgocitinib 0.5% in Japanese adult patients with moderate-to-severe AD and compared with placebo in adult patients with all-severity AD from a Japanese public health-care perspective.
在日本，地法米司特已被证明是治疗特应性皮炎（AD）的有效药物，但其成本效益仍不明确。因此，本研究的目的是从日本公共卫生保健的角度，确定1%地法米司特与0.5%地尔戈替诺相比，在日本中重度AD成年患者中的成本效益，以及与安慰剂相比，在所有严重程度AD的日本成年患者中的成本效益。
从日本公共卫生保健的角度，使用成本效益模型进行分析。该模型根据湿疹面积和严重程度指数评分定义了四种健康状态（“清除”、“轻度”、“中度”和“重度”）。分析的时间范围为1年。由于分析期较短，未应用贴现率。模型中采用了先前通过锚定匹配调整间接比较估计的患者比例。该模型还填充了来自文献的数据。主要模型结果包括质量调整生命年（QALY）、成本和结果，包括增量成本效益比。所有价格均以2018年4月至2019年3月的价格水平以日元表示。进行了单向敏感性分析和概率敏感性分析（PSA），以评估结果的稳健性。
在基础案例中，1%地法米司特与0.5%地尔戈替诺和安慰剂相比的成本效益分别为827,054日元/QALY和1,518,657日元/QALY。PSA显示，1%地法米司特与0.5%地尔戈替诺和安慰剂相比的成本效益分别有66.6%和99.6%的概率低于500万日元/QALY的阈值。
结果表明，从日本公共卫生保健的角度来看，在日本中重度AD成年患者中，1%地法米司特与0.5%地尔戈替诺相比是更具成本效益的治疗选择，在所有严重程度AD的成年患者中，与安慰剂相比也是如此。
