[Cost-Utility Analysis of Dupilumab for the Treatment of Severe Atopic Dermatitis in Children and Adolescents in Italy]

IF 0.4 Q4 HEALTH CARE SCIENCES & SERVICES Farmeconomia-Health Economics and Therapeutic Pathways Pub Date : 2022-06-22 DOI:10.7175/fe.v23i1.1527
E. Galli, M. Pedone, Miryana Dobreva, R. Bitonti, R. Di Turi
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Abstract

BACKGROUND AND OBJECTIVE: Atopic dermatitis (AD) is a chronic, multifactorial, inflammatory condition characterized by a significant impact on patients’ quality of life. Dupilumab is reimbursed by the Italian Medicines Agency (AIFA) for the treatment of adolescent and adult patients with severe AD (according to AIFA registry criteria). Recently, dupilumab has been reimbursed in the treatment of children with severe AD. The objective of this analysis was to estimate the incremental cost-utility ratio (ICUR) of dupilumab compared to current supportive care (SC), for the treatment of severe AD in children (6-11 years) and adolescents (12-17 years) in Italy.MATERIALS AND METHODS: Cost-effectiveness analysis was conducted using a 1-year decision tree followed by a Markov model over a lifetime period. The base case analysis was performed on the overall population of the LIBERTY AD ADOL (NCT03054428) and LIBERTY AD PEDS (NCT03345914) studies, adopting the National Health Service (NHS) perspective. The following costs were considered: acquisition of treatment, management of disease, adverse events and complications. The robustness of the model was tested through sensitivity analysis. In addition, a scenario analysis adopting the social perspective was performed.RESULTS: In the base case, over a lifetime, dupilumab was more effective than SC in both children and adolescents (+2.44 and +1.62 quality-adjusted life years—QALYs, respectively). The introduction of dupilumab generated an increase in treatment costs (+€ 64,800 and +€ 52,853 € for children and adolescents, respectively), partially offset by a decrease in the costs of disease management and complications. Incremental cost-utility ratios (ICURs) were € 21,189 per QALY gained, for children, and € 26,569 per QALY gained, for adolescents. In both cases, the ICUR was lower than the willingness to pay threshold considered in Italy (€ 50,000 per QALY gained). Both the deterministic and probabilistic sensitivity analysis confirmed the robustness of the base case results. Finally, the scenario analysis, adopting the social perspective, showed coherent results compared to the base case.DISCUSSION: Dupilumab is a cost-effective option for the treatment of children and adolescents with severe AD eligible for systemic treatment in Italy compared to SC, from both the NHS and social perspective, confirming the results obtained in the adult population.
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【Dupilumab治疗意大利儿童和青少年严重特应性皮炎的成本-效用分析】
背景与目的:特应性皮炎(AD)是一种慢性、多因素的炎症性疾病,其特点是对患者的生活质量有显著影响。Dupilumab由意大利药品管理局(AIFA)报销,用于治疗青少年和成人严重AD患者(根据AIFA注册标准)。最近,dupilumab已被报销用于治疗严重AD患儿。本分析的目的是评估dupilumab与当前支持治疗(SC)相比的增量成本效用比(ICUR),用于治疗意大利儿童(6-11岁)和青少年(12-17岁)的严重AD。材料和方法:成本-效果分析采用1年的决策树和马尔可夫模型进行。采用国家卫生服务(NHS)的观点,对LIBERTY AD ADOL (NCT03054428)和LIBERTY AD PEDS (NCT03345914)研究的总体人群进行基本病例分析。考虑了以下费用:获得治疗、疾病管理、不良事件和并发症。通过敏感性分析检验模型的稳健性。此外,采用社会视角进行情景分析。结果:在基本情况下,在儿童和青少年的一生中,dupilumab比SC更有效(分别为+2.44和+1.62质量调整生命年)。dupilumab的引入导致了治疗费用的增加(儿童和青少年分别为+ 64,800欧元和+ 52,853欧元),部分被疾病管理和并发症费用的减少所抵消。儿童的增量成本效用比(ICURs)为21,189欧元/ QALY,青少年的增量成本效用比为26,569欧元/ QALY。在这两种情况下,ICUR都低于意大利考虑的支付意愿门槛(每获得QALY 50,000欧元)。确定性和概率敏感性分析均证实了基本情况结果的稳健性。最后,采用社会视角的情景分析显示了与基本情况相一致的结果。讨论:从NHS和社会的角度来看,与SC相比,Dupilumab是治疗在意大利有资格接受全身治疗的严重AD儿童和青少年的一种成本效益选择,证实了在成人人群中获得的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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