BACKGROUND: Dupilumab, currently the only approved systemic therapy for prurigo nodularis (PN), may be given on top of standard-of-care (SOC) treatments (e.g., topical corticosteroids and calcineurin inhibitors).
OBJECTIVE: We evaluated the cost-effectiveness of dupilumab 300mg every 2 weeks (Q2W) + SOC versus SOC alone for the treatment of adults with PN inadequately controlled by SOC. We used a United States (US) private health insurance payer perspective.
METHODS: We developed a short-term 24-week decision tree followed by a lifetime Markov extrapolation with 2 treatment arms: dupilumab + SOC versus SOC. In the base case, response was defined as an improvement of ≥4 on the Worst-Itch Numerical Rating Scale (scale, 0╴10); response rates were 58.8% with dupilumab + SOC and 19.0% with SOC alone. Clinical and EQ-5D-5L values were derived from two 24-week Randomized Clinical Trials of dupilumab in adults with PN (PRIME and PRIME 2). Estimates of resource use and costs were derived from published literature. Using the previously published US net price of dupilumab in atopic dermatitis (AD), we estimated quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratio (ICER). Costs and QALYs were discounted at an annual rate of 3.0%.
RESULTS: In the base-case analysis, dupilumab + SOC was associated with an additional 0.8 QALYs when compared to SOC (13.5 vs. 12.7) and more Lys with response (4.1 vs. 0.4). The deterministic ICER was $102,700/QALY gained. Results were robust in probabilistic and one-way sensitivity analyses. The ICER, from 10,000 iterations of the PSA, was $102,600/QALY ranging from $89,000/QALY to $136,700/QALY.
CONCLUSION: Compared with SOC alone, dupilumab 300mg Q2W + SOC is cost-effective for the treatment of adult patients with PN inadequately controlled by SOC in a US private health insurance setting.
