A Model-Based Cost-Effectiveness Analysis of Abrocitinib Compared with Upadacitinib and Baricitinib for Moderate-to-Severe Atopic Dermatitis: A UK Healthcare Perspective

Background and objective: Janus kinase inhibitors (JAKi) are systemic therapies recommended by the National Institute for Health and Care Excellence (NICE) for moderate-to-severe atopic dermatitis (AD). However, no direct cost-effectiveness analyses of JAKi exist to guide decision-making. We evaluated the cost-effectiveness of abrocitinib versus upadacitinib and baricitinib in treating moderate-to-severe AD from a UK National Health Service (NHS) perspective.

Methods

A decision tree captured short-term outcomes before patients transitioned to a Markov model (lifetime horizon; 1-year cycle length). Patients not responding (≥ 75% improvement in Eczema Area and Severity Index [EASI-75]) by week 16 stopped treatment. Published data informed response rates and relative efficacy. Patients initially received the lower licensed dose, with up-titration by week 12 in non-responders. Outputs included cost per response (week 16), cost per sustained response (week 52) and incremental cost-effectiveness ratios (ICERs; incremental cost per incremental quality-adjusted life year [QALY]).