Cost-effectiveness Analysis of Dupilumab for the Treatment of Adult Patients with Severe Prurigo Nodularis in Italy

Prurigo nodularis is characterized by intensely pruritic nodules that significantly impact patients' quality of life. This study aims to evaluate the cost-effectiveness of dupilumab compared with the best supportive care for the treatment of severe prurigo nodularis from the perspective of the Italian National Health Service. A cost-effectiveness model was developed using a decision tree followed by a Markov approach with a lifetime horizon (30 years). Baseline characteristics, efficacy, and utility data were derived from the pooled analysis of PRIME and PRIME2 trials. Direct healthcare costs based on drug acquisition, adverse event and complications management, and disease-related healthcare resource utilization were considered. Dupilumab improved health outcomes, with an incremental gain of 1.481 quality-adjusted life-years compared with best supportive care. The total cost of dupilumab treatment was €148,964, compared with €70,957 for the best supportive care arm, thus resulting in an incremental cost-effectiveness ratio of €52,661 per quality-adjusted life-year. Scenario analyses indicated that at a discount ≥ 20%, the incremental cost-effectiveness ratio was lower than €40,000/quality-adjusted life-year. Deterministic and probabilistic sensitivity analyses confirmed the robustness of the results. Dupilumab is likely to be a cost-effective treatment for severe prurigo nodularis patients eligible for systemic therapy in Italy, as it reduces disease burden and healthcare costs associated with uncontrolled prurigo nodularis.