Dupilumab injection in the treatment of moderate to severe atopic dermatitis in adults: a cost-effectiveness analysis_Chinese Journal of Evidence-Based Medicine

Authors：

AN Qi , SUN Jinnan ,  XU Wei

1. School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, P. R. China;

Corresponding?author：

XU Wei, Email: xu2012wei@126.com

Keywords：

Dupilumab; Optimal supportive care; Markov model; Cost-utility analysis

DOI：

10.7507/1672-2531.202306168

Video：

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Objective To evaluate the economics of duplizumab in combination with optimal supportive care versus optimal supportive care for moderate-to-severe atopic dermatitis in adults from the perspective of our health system. Methods A Markov model embedded in a decision tree was constructed to compare the long-term cost-utility of dupilumab combined with optimal supportive care versus optimal supportive care, and a sensitivity analysis was performed on the results. Results The results of the basic analysis showed that compared with the optimal supportive care, dupliyuzumab in combination with optimal supportive care resulted in 3.82 more QALYs, while its cost was 125 549.42 yuan more. The ICER was 32 854.83 yuan/QALY, which was less than one times China's per capita GDP in 2022, and was economical. Univariate sensitivity analysis showed that factors such as Dupilumab-16-week post - no response utility value, Dupilumab-52-week post response rate and Dupilumab-52-week adherence had a greater impact on the cost changes. The results of the probabilistic sensitivity analysis showed a stable model structure and good robustness. Conclusion In adult patients with moderate-to-severe atopic dermatitis, dupliyuzumab in combination with an optimal supportive care regimen is more cost-effective compared to an optimal supportive care regimen.

Citation： AN Qi, SUN Jinnan, XU Wei. Dupilumab injection in the treatment of moderate to severe atopic dermatitis in adults: a cost-effectiveness analysis. Chinese Journal of Evidence-Based Medicine, 2024, 24(4): 423-428. doi: 10.7507/1672-2531.202306168 Copy

1.	陳麗萍, 黃曉燕, 肖易, 等. 我國特應性皮炎、銀屑病、痤瘡和蕁麻疹的患病率及危險因素. 中南大學學報(醫學版), 2020, 45(4): 449-455.
2.	孫彩虹, 顧恒. 特應性皮炎的流行病學特征. 中國醫學文摘(皮膚科學), 2016, 33(2): 101-106, 84.
3.	Thomsen SF. Epidemiology and natural history of atopic diseases. Eur Clin Respir J, 2015, 2(1): 1.
4.	顧恒, 尤立平, 劉永生, 等. 我國10城市學齡前兒童特應性皮炎現況調查. 中華皮膚科雜志, 2004, 37(1): 29-31.
5.	Xu F, Yan S, Li F, et al. Prevalence of childhood atopic dermatitis: an urban and rural community-based study in Shanghai, China. PLoS One, 2012, 7(5): e36174.
6.	Guo Y, Li P, Tang J, et al. Prevalence of atopic dermatitis in Chinese children aged 1-7 ys. Sci Rep, 2016, 6: 29751.
7.	Wang X, Shi XD, Li LF, et al. Prevalence and clinical features of adult atopic dermatitis in tertiary hospitals of China. Medicine (Baltimore), 2017, 96(11): e6317.
8.	解讀中國特應性皮炎診療指南(2020版). 中國社區醫師, 2020, 36(24): 91.
9.	Blauvelt A, de Bruin-Weller M, Gooderham M, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet, 2017, 389(10086): 2287-2303.
10.	Boguniewicz M, Alexis AF, Beck LA, et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract, 2017, 5(6): 1519-1531.
11.	Smith S, Baker C, Gebauer K, et al. Atopic dermatitis in adults: an Australian management consensus. Australas J Dermatol, 2020, 61(1): 23-32.
12.	Kuznik A, Bégo-Le-Bagousse G, Eckert L, et al. Economic evaluation of dupilumab for the treatment of moderate-to-severe atopic dermatitis in adults. Dermatol Ther (Heidelb), 2017, 7(4): 493-505.
13.	Antonio C, Gianluca F, Rossella B, et al. Cost-effectiveness analysis of dupilumab for the treatment of severe atopic dermatitis in adults in Italy. Global Reg Health Tech Assess, 2020, 7(1): 578.
14.	Fanelli F, Pedone MP, Serra A, et al. PBI11 cost-effectiveness analysis of dupilumab for the treatment of atopic dermatitis in adolescent patients in Italy. Value in Health, 2020, 23(S2): 55.
15.	《中國藥物經濟學評價指南》課題組. 中國藥物經濟學評價指南(20011版). 中國藥物經濟學, 2011, (3): 7-48.
16.	de Bruin-Weller M, Tha?i D, Smith CH, et al. Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase Ⅲ clinical trial (LIBERTY AD CAFé). Br J Dermatol, 2018, 178(5): 1083-1101.
17.	Zhao Y, Wu L, Lu Q, et al. The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol, 2022, 186(4): 633-641.
18.	Costanzo A, Furneri G, Bitonti R, et al. Analisi costo-utilità di dupilumab per il trattamento della dermatite atopica grave negli adulti in Italia. Glob Reg Health Technol Assess, 2020, 7: 57-65.
19.	張劍聰, 譚飛莉, 黎偉達. 2種方案治療皮膚淺表真菌病的成本-效果分析. 中國醫藥指南, 2008, 6(15): 8-9.
20.	李康寯, 俞阿勇, 楊新軍. 兩種方案治療過敏性結膜炎最小成本分析. 藥物流行病學雜志, 2009, 18(2): 126-128.
21.	胡俊華, 張艷霞, 胡艷秋, 等. 不同劑量吸入性皮質類固醇聯合長效β2激動劑治療成人持續性哮喘患者的效果及成本-效益分析. 中國藥物濫用防治雜志, 2022, 28(6): 736-739, 744.
22.	Wang L, Zhang J, He X, et al. POSC396 real-world treatment pattern and direct medical costs of atopic dermatitis in china: a retrospective claims database analysis. Value in Health, 2022, 25(1): 67.
23.	肖珊, 劉麗英, 鄭瑞慶, 等. 2種中西結合方案治療普通型手足口病的成本-效果分析. 中國當代醫藥, 2016, 23(26): 133-136.
24.	藥智網. 度普利尤單抗單價. 2022.
25.	石魯月, 羅一夫, 崔永超, 等. 布地奈德福莫特羅粉吸入劑與沙美特羅替卡松粉吸入劑治療哮喘的成本-效果分析. 臨床合理用藥雜志, 2022, 15(4): 28-31, 35.
26.	Brown MM, Brown GC, Brown HC, et al. Value-based medicine, comparative effectiveness, and cost-effectiveness analysis of topical cyclosporine for the treatment of dry eye syndrome. Arch Ophthalmol, 2009, 127(2): 146-152.
27.	Jeffrey A. Biologic therapies for treatment of asthma associated with type 2 inflammation: effectiveness, value, and value-based price benchmarks. 2018.
28.	Poole CD, Bannister CA, Andreasen JN, et al. Estimation of health-related utility (EQ-5D index) in subjects with seasonal allergic rhinoconjunctivitis to evaluate health gain associated with sublingual grass allergen immunotherapy. Health Qual Life Outcomes, 2014, 12: 99.
29.	NICE. Dupilumab for treating moderate to severe atopic dermatitis. 2022.

1. 陳麗萍, 黃曉燕, 肖易, 等. 我國特應性皮炎、銀屑病、痤瘡和蕁麻疹的患病率及危險因素. 中南大學學報(醫學版), 2020, 45(4): 449-455.
2. 孫彩虹, 顧恒. 特應性皮炎的流行病學特征. 中國醫學文摘(皮膚科學), 2016, 33(2): 101-106, 84.
3. Thomsen SF. Epidemiology and natural history of atopic diseases. Eur Clin Respir J, 2015, 2(1): 1.
4. 顧恒, 尤立平, 劉永生, 等. 我國10城市學齡前兒童特應性皮炎現況調查. 中華皮膚科雜志, 2004, 37(1): 29-31.
5. Xu F, Yan S, Li F, et al. Prevalence of childhood atopic dermatitis: an urban and rural community-based study in Shanghai, China. PLoS One, 2012, 7(5): e36174.
6. Guo Y, Li P, Tang J, et al. Prevalence of atopic dermatitis in Chinese children aged 1-7 ys. Sci Rep, 2016, 6: 29751.
7. Wang X, Shi XD, Li LF, et al. Prevalence and clinical features of adult atopic dermatitis in tertiary hospitals of China. Medicine (Baltimore), 2017, 96(11): e6317.
8. 解讀中國特應性皮炎診療指南(2020版). 中國社區醫師, 2020, 36(24): 91.
9. Blauvelt A, de Bruin-Weller M, Gooderham M, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet, 2017, 389(10086): 2287-2303.
10. Boguniewicz M, Alexis AF, Beck LA, et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract, 2017, 5(6): 1519-1531.
11. Smith S, Baker C, Gebauer K, et al. Atopic dermatitis in adults: an Australian management consensus. Australas J Dermatol, 2020, 61(1): 23-32.
12. Kuznik A, Bégo-Le-Bagousse G, Eckert L, et al. Economic evaluation of dupilumab for the treatment of moderate-to-severe atopic dermatitis in adults. Dermatol Ther (Heidelb), 2017, 7(4): 493-505.
13. Antonio C, Gianluca F, Rossella B, et al. Cost-effectiveness analysis of dupilumab for the treatment of severe atopic dermatitis in adults in Italy. Global Reg Health Tech Assess, 2020, 7(1): 578.
14. Fanelli F, Pedone MP, Serra A, et al. PBI11 cost-effectiveness analysis of dupilumab for the treatment of atopic dermatitis in adolescent patients in Italy. Value in Health, 2020, 23(S2): 55.
15. 《中國藥物經濟學評價指南》課題組. 中國藥物經濟學評價指南(20011版). 中國藥物經濟學, 2011, (3): 7-48.
16. de Bruin-Weller M, Tha?i D, Smith CH, et al. Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase Ⅲ clinical trial (LIBERTY AD CAFé). Br J Dermatol, 2018, 178(5): 1083-1101.
17. Zhao Y, Wu L, Lu Q, et al. The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol, 2022, 186(4): 633-641.
18. Costanzo A, Furneri G, Bitonti R, et al. Analisi costo-utilità di dupilumab per il trattamento della dermatite atopica grave negli adulti in Italia. Glob Reg Health Technol Assess, 2020, 7: 57-65.
19. 張劍聰, 譚飛莉, 黎偉達. 2種方案治療皮膚淺表真菌病的成本-效果分析. 中國醫藥指南, 2008, 6(15): 8-9.
20. 李康寯, 俞阿勇, 楊新軍. 兩種方案治療過敏性結膜炎最小成本分析. 藥物流行病學雜志, 2009, 18(2): 126-128.
21. 胡俊華, 張艷霞, 胡艷秋, 等. 不同劑量吸入性皮質類固醇聯合長效β2激動劑治療成人持續性哮喘患者的效果及成本-效益分析. 中國藥物濫用防治雜志, 2022, 28(6): 736-739, 744.
22. Wang L, Zhang J, He X, et al. POSC396 real-world treatment pattern and direct medical costs of atopic dermatitis in china: a retrospective claims database analysis. Value in Health, 2022, 25(1): 67.
23. 肖珊, 劉麗英, 鄭瑞慶, 等. 2種中西結合方案治療普通型手足口病的成本-效果分析. 中國當代醫藥, 2016, 23(26): 133-136.
24. 藥智網. 度普利尤單抗單價. 2022.
25. 石魯月, 羅一夫, 崔永超, 等. 布地奈德福莫特羅粉吸入劑與沙美特羅替卡松粉吸入劑治療哮喘的成本-效果分析. 臨床合理用藥雜志, 2022, 15(4): 28-31, 35.
26. Brown MM, Brown GC, Brown HC, et al. Value-based medicine, comparative effectiveness, and cost-effectiveness analysis of topical cyclosporine for the treatment of dry eye syndrome. Arch Ophthalmol, 2009, 127(2): 146-152.
27. Jeffrey A. Biologic therapies for treatment of asthma associated with type 2 inflammation: effectiveness, value, and value-based price benchmarks. 2018.
28. Poole CD, Bannister CA, Andreasen JN, et al. Estimation of health-related utility (EQ-5D index) in subjects with seasonal allergic rhinoconjunctivitis to evaluate health gain associated with sublingual grass allergen immunotherapy. Health Qual Life Outcomes, 2014, 12: 99.
29. NICE. Dupilumab for treating moderate to severe atopic dermatitis. 2022.

Chinese Journal of Evidence-Based Medicine

Dupilumab injection in the treatment of moderate to severe atopic dermatitis in adults: a cost-effectiveness analysis

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