Economic evaluation of a JAK inhibitor compared to a monoclonal antibody for treatment of moderate-to-severe atopic dermatitis from a UK perspective

Abstract

Aim

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by severe itching, erythema and scaling, causing pain, stigmatization and social isolation. Despite the growing availability of treatment options, unmet care needs remain. This research aimed to assess the cost-effectiveness of a novel JAK inhibitor (JAKi) compared to a monoclonal antibody and to identify key drivers of cost-effectiveness.

Materials and methods

A de novo economic model was developed to assess the cost-effectiveness of a novel JAKi compared to an established monoclonal antibody for the treatment of moderate-to-severe AD patients from a UK perspective. A targeted literature review was conducted to inform the development of the economic model with an advanced model structure. Various scenario and sensitivity analyses were performed to account for parameter- and structural uncertainty and to identify key drivers of cost-effectiveness.

Results

The JAKi was not cost-effective compared to the monoclonal antibody (£219,733.88 per quality-adjusted life year (QALY) gained) at selected price levels when applying the UK willingness-to-pay threshold of £30,000 per QALY gained. Key drivers of cost-effectiveness were utility values, intervention efficacy and drug acquisition costs. A decrease in JAKi’s dose costs, as well as a lower dose, lead to cost-effectiveness.

Limitations

Assumptions regarding parameter inputs were necessary, therefore a considerable level of uncertainty regarding efficacy and cost data is to be accounted for in the interpretation of the results. In particular, the efficacy data were based on single clinical studies.

Conclusions

This research revealed the cost-effectiveness of a JAKi compared to a monoclonal antibody for the treatment of moderate-to-severe AD to be highly sensitive to the costs and effectiveness inputs and identified further cost-effectiveness drivers. It demonstrated that the JAKi could be cost-effective compared to an established monoclonal antibody with a lower dose or a reduced price.

Keywords:

• Atopic dermatitis
• atopic eczema
• cost-effectiveness
• dupilumab
• economic evaluation
• JAK inhibitor
• upadacitinib

JEL CLASSIFICATION CODES:

• I10
• I1
• I
• I19

Transparency

Declaration of funding

This research did not receive funding.

Declaration of financial/other relationships

DW is a registered Ph.D. student at Maastricht University and an employee of UCB Pharma, UCB Pharma had no role in the writing or reviewing of this manuscript. All other authors declare no conflict of interest. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by KH and DW. The manuscript was written by KH and all authors provided feedback throughout the development of the manuscript. All authors read and approved the final manuscript. All authors sufficiently contributed to this research according to ICMJE criteria to qualify as listed authors.

Acknowledgements

The authors would like to thank UCB Pharma for the knowledge support on the understanding of the disease.