Cost-utility analysis of upadacitinib vs. dupilumab for atopic dermatitis in Australia

Treatment for atopic dermatitis (AD) has been revolutionized by therapies such as dupilumab and upadacitinib, although these drugs are more costly than standard immunosuppressants.

To evaluate the cost-effectiveness of upadacitinib vs. dupilumab as first-line therapy for adults with AD.

A cost-utility analysis was conducted from the Australian healthcare sector perspective. A Markov cohort model with 16-week cycles over a 5-year time horizon was constructed to simulate disease progression following first-line therapy with upadacitinib or dupilumab. Patients who failed to achieve controlled disease on first-line therapy were switched to second-line therapy with the alternate medication, then third-line therapy with mycophenolate mofetil. Cost data were obtained from public reimbursement schedules. Efficacy and utility data were sourced from real-world clinical data, published literature and expert consensus. Sensitivity analyses were conducted to account for uncertainties in parameter inputs. The primary outcomes were 2024 Australian dollars ($), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).

Compared with dupilumab, first-line upadacitinib gained 0.04 QALYs at an increased cost of $3213 over 5 years, resulting in an ICER of $88 778/QALY. Therefore, upadacitinib is not cost-effective compared with dupilumab at a $50 000/QALY threshold, with marginally increased effectiveness at higher costs. These results were highly sensitive to variations in the probability of disease control on either therapy and medication costs but remained robust across a range of willingness-to-pay thresholds.

Upadacitinib is unlikely to be cost-effective compared with dupilumab; however, the minimal differences in outcomes suggest that both treatments may be comparable options for first-line therapy.