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Cost-Per-Responder Analysis for Tralokinumab and Dupilumab in Combination with Topical Corticosteroids in Patients
Marni Wiseman1,2, Marco Benvenuto3, Liv Strømkjær4
1Wiseman Dermatology Research Inc., 6-1170 Taylor Ave, Winnipeg, MB, Canada.
Introduction:
Atopic dermatitis (AD) is a chronic inflammatory skin disease, and patients with moderate-to-severe AD may require treatment with biologics in combination with topical corticosteroids (TCS). The evidence of the cost-effectiveness of biologics in AD is scarce.
Methods:
A country-specific cost-per-responder analysis comparing tralokinumab in combination with TCS to dupilumab in combination with TCS was performed for France, Germany, Italy, UK, and Canada based on efficacy estimates (at week 32) from a matching-adjusted indirect comparison (MAIC). Response was defined as either a 75% reduction in the Eczema Area and Severity Index (EASI-75) or an Investigator's Global Assessment score of 0-1 (IGA-0/1). The analysis was repeated with different proportions (10-50%) of patients switching from once every 2 weeks (Q2W) to once every 4 weeks (Q4W) dosing (as per label) for tralokinumab from week 16 to week 32.
Results:
The cost per EASI-75 responder for tralokinumab + TCS ranged from €7118.57 to €13,918.80 in France, Germany, Italy, and UK, and in Canada it was C$19,466.03 when 40% of patients using tralokinumab switched from Q2W to Q4W dosing per label. The cost per EASI-75 responder for dupilumab + TCS ranged from €12,380.21 to €18,065.16 and C$23,140.33. The cost per EASI-75 and IGA-0/1 responder for tralokinumab + TCS was lower than for dupilumab, irrespective of the country and the proportion switching from Q2W to Q4W. The proportion of patients switching from Q2W to Q4W dosing for tralokinumab proportionally decreased the average cost per responder at week 32.
Conclusion:
In France, Germany, Italy, UK, and Canada, tralokinumab in combination with TCS may be more cost-effective for moderate-to-severe AD than dupilumab in combination with TCS at week 32 for EASI-75 and IGA-0/1 responders. The difference in cost-effectiveness depends on the efficacy and cost of the treatments and on the proportion of patients treated with tralokinumab who switch per label from Q2W to Q4W, which additionally reduces treatment cost.
Clinical Trial Registration:
LIBERTY AD CHRONOS [10] NCT02260986, ECZTRA 3 [9] NCT03363854.
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