Cost per responder of upadacitinib 30 mg and dupilumab 300 mg in patients with moderate-to-severe atopic dermatitis in italy

Purpose: The objective of this economic evaluation was to compare the cost per responder between upadacitinib (Upa) 30 mg and dupilumab (Dup) 300 mg in patients with moderate-to-severe atopic dermatitis in Italy. Methods: A cost per responder analysis was developed based on results of Heads Up, a head-to-head randomized clinical trial. The primary endpoint was EASI75 at week 16, and the secondary endpoints were EASI90, EASI100, and WP-NRS improvement >= 4 points at week 16. The analysis also assessed a fifth exploratory endpoint from a Heads Up post-hoc analysis: EASI90 & WP-NRS 0/1 at week 16. The cost per responder was based on the perspective of the Italian National Health System (I-NHS). Ex-factory prices were used, excluding mandatory and other hidden discounts. The treatment cost was based on the number of administrations at week 16. The cost per responder was adopted as a cost-effectiveness indicator. Results: Independently of the endpoint evaluated, upadacitinib always had the lower cost per responder than dupilumab. In the base case, the cost-effectiveness of upadacitinib ranges from a minimum of <euro>361.50 considering EASI75 index at week 16 (Upa: <euro>8,839.78 vs. Dup: <euro>9,201.28) to a maximum of <euro>50,376.18 considering EASI100 index at week 16 (Upa: <euro>22,535.2 vs. Dup: <euro>72,911.39). The difference in cost per responder between upadacitinib and dupilumab increased with higher EASI response levels. Conclusion: Considering five clinical endpoints, the cost per responder for upadacitinib 30 mg was always lower than for dupilumab 300 mg, highlighting its substantial clinical and economic benefits for patients with moderateto-severe atopic dermatitis.