A Cost-per-Responder Analysis of Ritlecitinib vs Baricitinib in Severe Alopecia Areata

Ritlecitinib, a JAK3/TEC family kinase inhibitor, and baricitinib, a JAK1/2 inhibitor, are approved for treating severe alopecia areata (AA).

Develop a cost-per-responder analysis for ritlecitinib and baricitinib for treating severe AA to estimate the budget impact based on clinical efficacy, available dosages, and pricing structure.

A decision tree evaluated cost implications of once-daily ritlecitinib 50 mg, or baricitinib 2 mg and 4 mg treatment over 1 year from a US perspective. Drug costs were estimated using wholesale acquisition costs. Distribution across treatment and dosing options were based on real-world evidence. We defined shorter-term response as Severity of Alopecia Tool (SALT) score relative change from baseline ≥30% (SALT Δ≥30%; SALT₃₀) at Weeks 18 and 24, and longer-term response as absolute SALT score ≤20 at Weeks 36 and 52. Patients initiating baricitinib 2 mg with no shorter-term response could uptitrate to 4 mg or discontinue therapy. Decision probabilities were derived from real-world evidence and clinical trial data.

At Week 24, 52.10% of ritlecitinib initiators and 36.28% of baricitinib initiators achieved SALT Δ ≥30%; at Week 52, 40.26% and 30.63% of ritlecitinib and baricitinib initiators, respectively, achieved SALT ≤20. Baricitinib had a higher cost per responder than ritlecitinib at Weeks 24 ( $54\hspace{0.17em}887vs$ 45 577) and 52 ( $107\hspace{0.17em}217vs$ 94 834). Cost-equivalence was reached at Week 52 ( $38\hspace{0.17em}180),with42.72$ 1532) and higher at Week 52 (difference, $10\hspace{0.17em}728)thanonlybaricitinib2mguse,andloweratWeeks24and52(difference,-$ 20 001 and -$60 073) than only baricitinib 4 mg use. The lower cost per responder for ritlecitinib 50 mg vs baricitinib 2 or 4 mg at Weeks 24 and 52, and greater early efficacy and fewer discontinuations is consistent with the results of a prior indirect treatment comparison that supported favorable outcomes with ritlecitinib 50 mg vs baricitinib 2 mg.

Ritlecitinib 50 mg demonstrated a lower cost per responder than baricitinib 2 or 4 mg at Weeks 24 and 52, which may inform reimbursement or formulary inclusion of ritlecitinib for treating AA.