Pharmacoeconomical analysis of the use of upadacitinib, baricitinib and dupilumab for systemic therapy of patients with moderate and severe atopic dermatitis

Objective. Comparative pharmacoeconomic evaluation of upadacitinib, baricitinib and dupilumab for the treatment of moderate to severe atopic dermatitis.

Materials and methods. Study design — retrospective. Pharmacoeconomic analysis method — cost-effectiveness analysis, budget impact analysis. Data sources. On the effectiveness of compared alternatives — meta-analysis of randomized clinical trials for the compared drugs, clinical recommendations; on the cost of drugs — the state register of maximum selling prices.

Results. Lowest cost-effectiveness (CER) values for both EASI-75 and EASI-90 responses were for upadacitinib. For upadacitinib 15 mg/day, the cost of achieving EASI-75 and EASI-90 responses was reduced by 63.9 and 70.3%, respectively compared to dupilumab and by 44.2 and 46.8% compared to baricitinib. For upadacitinib 30 mg/day, the reduction in the cost of achieving the effect compared to dupilumab will be, respectively, 40.8 and 56.2%, and compared with baricitinib — 8,5 and 21.4%. The budget impact analysis (BIA) showed that the increase in the share of upadacitinib from 15 to 35%, and the proportion of baricitinib — from 5 to 10% due to a decrease in the proportion of patients, receiving dupilumab will reduce the budget impact in the treatment of patients with severe atopic dermatitis on the scale of the Russian Federation by a total of 11.6% (RUB 1.25 billion) with a single-step change from the first year and by 7.9% (RUB 0.86 billion) with a gradual change over 3 years. An analysis of missed opportunities showed that if the share of upadacitinib changes to 35% 741 patients can be additionally provided with therapy in the first year, 629 patients in the second year and 567 patients in the third (with a target population size of 4929 patients).

Conclusion. Increasing the share of upadacitinib will not only significantly reduce the burden on the budget of the healthcare system by refusing to use more expensive dupilumab in some patients, but also increase the proportion of patients achieving the goals of therapy in terms of EASI-75 and EASI-90.

1. Klinicheskie rekomendacii. Atopicheskij dermatit / Rossijskoe obshchestvo dermatovenerologov i kosmetologov, Rossijskaya associaciya allergologov i klinicheskih immunologov, Soyuz pediatrov Rossii. Moskva, 2020. (In Russ.).

2. Kubanov AA, Bogdanova EV. Dermatovenereologic health care delivery management in the Russian Federation. Results of 2018. Vestnik dermatologii i venerologii. 2019;95(4):8–23. (In Russ.).

3. Wollenberg A, Barbarot S, Bieber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J. Eur. Acad. Dermatol. Venereol. 2018 May;32(5):657–82. doi: 10.1111/jdv.14891

4. Официальный сайт Федеральной антимонопольной службы РФ. Режим доступа: https://fas.gov.ru/.

5. Silverberg JI, Hong HC, Thyssen JP, et al. Comparative Efficacy of Targeted Systemic Therapies for Moderate to Severe Atopic Dermatitis without Topical Corticosteroids: Systematic Review and Network Meta-analysis. Dermatol. Ther. (Heidelb.). 2022 May;12(5):1181–96. doi: 10.1007/s13555-022-00721-1

6. https://pubmed.ncbi.nlm.nih.gov/?term=dupilumab+AND+baricitinib+AND+upapacitinib+AND+atopic+dermatitis.

7. Instrukciya po medicinskomu primeneniyu preparata Olumiant (baricitinib). (In Russ.). Режим доступа: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=841caf45-8158-491f-b743-6f0bd377e4ae (дата обращения: 01.06.2023).

8. Instrukciya po medicinskomu primeneniyu preparata Ranvek (upadacitinib). (In Russ.). Режим доступа: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=f9c192db-e07b-4d3c-b856-b5e6c7f1ab5b (дата обращения: 01.06.2023).

9. Instrukciya po medicinskomu primeneniyu preparata Dupiksent (dupilumab). (In Russ.). Режим доступа: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=5cb00570-024f-44ff-9091-e43a64c01ec6 (дата обращения: 01.06.2023).

10. Chislennost' naseleniya Rossijskoj Federacii po polu i vozrastu na 1 yanvarya 2021 goda. Statisticheskij byulleten' / Federal'naya sluzhba gosudarstvennoj statistiki. Moskva, 2021. (In Russ.). Режим доступа: https://rosstat.gov.ru/storage/mediabank/Bul_chislen_nasel-pv_01-01-2021.pdf (дата обращения: 01.06.2023).

11. Silverberg JI, Simpson EL. Associations of childhood eczema severity: a US population-based study. Dermatitis. 2014 May-Jun;25(3):107–14. doi: 10.1097/DER.0000000000000034

12. Chiesa Fuxench ZC, Block JK, Boguniewicz M, et al. Atopic Dermatitis in America Study: ACross-Sectional Study Examining the Prevalence and Disease Burden of Atopic Dermatitis in the US Adult Population. J. Invest. Dermatol. 2019 Mar;139(3):583–90. doi: 10.1016/j.jid.2018.08.028

13. Государственный реестр предельных отпускных цен. Режим доступа: https://grls.rosminzdrav.ru/pricelims.aspx.