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

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. 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]). Costs per EASI-75 response and cost per sustained response were £5035/£14,141 (abrocitinib), £5396/£16,843 (upadacitinib) and £7609/£16,172 (baricitinib). ICERs for abrocitinib were £422,948 per QALY lost (− 0.04 QALYs, − £16,243, south-west quadrant) versus upadacitinib and £69,336 per QALY gained (+ 0.26 QALYs, + £18,226, north-east quadrant) versus baricitinib. One-way sensitivity analyses (OWSA) indicated the cost-effectiveness results were most sensitive to the estimates of relative efficacy for upadacitinib and baricitinib. The analysis estimated that abrocitinib was cost-effective compared with upadacitinib for the treatment of adults with moderate-to-severe AD at willingness-to-pay thresholds of £20,000–30,000/QALY from the perspective of the UK NHS, despite a small QALY loss. In the comparison with upadacitinib, results were driven by early up-titration to the more expensive upadacitinib dose, which led to higher costs. Abrocitinib was not cost-effective compared with baricitinib, as double the patients discontinued baricitinib and switched to cheaper best supportive care. Furthermore, abrocitinib had the lowest cost per EASI-75 response and lowest cost per sustained response amongst all JAKi. These findings will aid clinicians and payers when prescribing JAKi in moderate-to-severe AD from a UK perspective.