The biologic dupilumab is projected to be a cost-effective treatment for moderate-to-severe atopic dermatitis, shows a new study.
The study, published in the July issue of the Journal of Drugs in Dermatology, compared the costs of dupilumab to the costs of topical treatments in adult patients with moderate-to-severe atopic dermati-tis whose disease was not under control or in adults who couldn’t use topical therapies.
The analysis found that the expected lifetime costs of a single patient treated with dupilumab was $509,600 ― which included $267,800 for the cost of dupilumab and $241,800 for other atopic dermati-tis-related expenses the patient incurred. This compares to $271,500 for patients receiving topical treatments alone. However, of note, dupilumab was associated with an additional 1.91 quality of life years (QALYs) and a positive cost-effectiveness ratio (ICER) of $124,500 as compared with $95,800 for patients with severe atopic dermatitis and $160,000 for patients with moderate atopic dermatitis.
“Dupilumab offers a new treatment option with the potential to significantly improve health out-comes,” says first author Marita Zimmermann, MPH, Ph.D., University of Washington, Seattle. “Yet most traditional atopic dermatitis treatments, such as emollients and moisturizers, have relatively low cost. Because both healthcare payers and patients are under increasing financial constraints, they may be forced to prioritize healthcare treatments. The added cost of dupilumab must be compared to the potential benefits it can provide to determine the relative value for money compared to other healthcare interventions.”
The authors collaborated with the Institute for Clinical and Economic Review (ICER) to complete the cost-effectiveness component of the analysis. “ICER’s goal is to be a trustworthy, independent source to inform the value of a new drug. When important new drugs enter the market, ICER aims to com-plete analyses to inform insurers, patients, providers, policymakers and drug makers on how well the drug works, how much better it is than current therapy and how much it could save us in expenses. Dupilumab became a focus for ICER as a new treatment in a disease area with few other options avail-able,” she said.
The results of the analysis were highly dependent on severity of atopic dermatitis.
“The more severe disease the patient had prior to beginning treatment, the more value dupilumab would likely provide,” Dr. Zimmerman said. “We had assumed there might be some trade-offs be-cause patients with moderate atopic dermatitis are more likely to respond to dupilumab treatment. Therefore, the time a patient used the drug was longer and the associated drug costs were higher. However, because quality of life for patients with severe disease was lower prior to beginning treat-ment, the improvement when beginning treatment was larger for this patient subgroup, which led to relatively higher value despite the higher costs.”
Because dupilumab was projected to be an effective and cost-effective treatment for moderate-to-severe atopic dermatitis, the drug could be an important addition to the treatment choices for patients who have thus far had limited options. “We hope that our study will be used by health insurers to in-form inclusion of dupilumab in their plan coverage, and by providers to inform use of dupilumab for their patient populations,” Dr. Zimmermann says.
The study process was improved by many conversations with and feedback from patients, physicians, manufacturers and other stakeholders. “In particular, the manufacturer of dupilumab (Regeneron) played an important role in providing data from their clinical trials, as well as drug cost estimates,” Dr. Zimmermann says. “In the past, manufacturers have often been reluctant to participate in this type of close collaboration with researchers for economic evaluations. Their willingness to work in partnership on this analysis led to a more accurate economic evaluation, which will be more relevant to payers, providers and patients, and therefore more useful in real-world settings.”
The manufacturer’s involvement in the study prior to product launch also allowed the company the opportunity to align the list price and rebate structure with the projected value-based price. “We hope this leads to quick and relatively smooth access to the drug for patients in need,” Dr. Zimmermann says.
One limitation throughout the study process was defining severity of atopic dermatitis. “It is a hetero-geneous condition with a wide range of severities and symptoms which are difficult to capture in a sin-gle model,” Dr. Zimmermann says.
The authors hope that their model of collaboration between researchers and manufacturers will be replicated for other health economic evaluations. “We believe that our model can not only lead to im-proved research quality, but can also improve access and outcomes for patients, and impact value for payers,” Dr. Zimmermann says. “At the same time, manufacturers can have the opportunity to demonstrate their commitment to patients and widespread access to novel therapies.”
Zimmermann M, Rind D, Chapman R, et al. “Economic Evaluation of Dupilumab for Moderate-to-Severe Atopic Dermatitis: A Cost-Utility Analysis,” Journal of Drugs in Dermatology, 2018 July 1;17(7):750-756.
This study was funded by the Institute for Clinical and Economic Review.