Budget Impact Analysis of System-Level Costs Associated With Topical Janus Kinase Inhibitor Therapies for Moderate Atopic Dermatitis in Germany

Objectives German statutory health insurance budgets are driven by escalation to advanced systemic therapies for atopic dermatitis (AD). Effective and affordable novel options for adults with AD are needed to reduce the economic burden. Our objective was to estimate the 5-year budget impact of adopting the topical Janus kinase inhibitor, 1.5% ruxolitinib cream, for adults with moderate AD, affected body surface area ≤ 20%, and clinical eligibility for systemic therapy from a German population perspective. Methods We developed a budget impact model that compares the current systemic treatment mix with a forward-looking intervention scenario in which 1.5% ruxolitinib cream is adopted for adult AD from 2026 onward. Uptake increases linearly to 25% by 2030 and proportionally displaces systemic therapies. Ruxolitinib cream costs were modeled based on real-world evidence. Direct costs included drug acquisition and nondrug medical costs; the societal perspective incorporated out-of-pocket costs and productivity losses. Results The systemic-eligible population was estimated at 330 600 patients in 2025, growing to 402 200 by 2030. Among those were 90 000 patients treated with 1.5% ruxolitinib cream in 2030. Over 2026 to 2030, costs were €39.8bn with ruxolitinib cream versus €44.1bn with current systemic treatments, yielding a cumulative budget impact of €4.3bn. Statutory health insurance savings accounted for 80% (€3.4bn) of those savings. Conclusions Under the modeled uptake and displacement assumptions, ruxolitinib cream could represent a cost-mitigating option that could reduce the economic burden of AD. Postlaunch evidence on utilization, persistence, and therapy switching is needed to validate and refine budget impact estimates.