Analisi costo-utilità di dupilumab per il trattamento della dermatite atopica grave negli adulti in Italia

BackgroundAtopic dermatitis (AD) is a chronic, multifactorial, inflammatory skin disease with significant impact on patients’ quality of life. ObjectiveThe objective of this analysis was to estimate the incremental cost-effectiveness ratio (ICER) of dupilumab, administered every other week, vs supportive care (SC), in the Italian adult population with severe AD, for whom ciclosporin treatment is contraindicated, ineffective or not tolerated. MethodsSimulation of outcomes and costs was undertaken using a 1-year decision tree, followed by a 20-year time horizon Markov model. Clinical data were derived from a pooled analysis of two studies. Given the uncertainty on final National Health Service (NHS) cost of dupilumab in Italy (confidential discount might be applied) multiple cost-utility analyses were conducted using different price hypotheses, starting from dupilumab published ex-manufacturer price, and progressively reducing it up to 50%. Model robustness were tested using sensitivity analyses. ResultsIn the base-case, dupilumab was more effective than SC (+1.92 quality adjusted life years, QALYs). In Analysis A (NHS perspective), -8.0% discount on dupilumab ex-manufacturer price was required to achieve an ICER<€50,000 QALY gained with dupilumab vs SC; in Analysis B (Societal perspective), dupilumab ICER vs SC was already below the acceptability threshold at its current published ex-manufacturer price. Both one-way deterministic and probabilistic sensitivity analyses confirmed robustness and reliability of base-case results. ConclusionsDupilumab is a cost-effective option for the treatment of patients with severe AD in Italy, compared with SC, when both NHS and societal economic consequences of AD treatment and management are considered.