ICER Report Ranks Value, Clinical Effectiveness of Dupilumab and Other AD Treatments Landing Page

Dupilumab was one of the most cost-effective treatments for moderate to severe atopic dermatitis (AD), according to a report¹ by the Institute for Clinical and Economic Review (ICER) which ranked the value and clinical effectiveness of five drugs and offered policy recommendations for stakeholders.

According to the ICER report, it is imperative that efforts be made to ensure patients with AD have access to treatments to improve health that do not aggravate existing health inequities. Clinical experts and patients alike both highlighted that high costs of treatments, access to specialists, and varied health insurance coverage—specifically high deductible plans—are all contributing factors to continued health inequities.

The ICER report¹ compared abrocitinib, baricitinib, tralokinumab, and upadacitinib with topical emollients (standard of care) and dupilumab. Researchers used placeholder prices for abrocitinib (average of baricitinib and aupadacitinib’s net prices) and tralokinumab (dupilumab’s net price), and estimated net prices for baricitinib, upadacitinib, and dupilumab, which are all currently marketed.

In comparison to the standard of care, baricitinib and dupilumab incurred the lowest and second lowest costs per quality-adjusted life-year gained, respectively. Additionally, baricitinib was marked as “less costly” and “less effective” than dupilumab.

Health Benefit Price Benchmarks (HBPBs) were also estimated for each drug in comparison to the standard of care:

• abrocitinib: from $30,600 to $41,800 (discounts not presented due to placeholder price)

• baricitinib: from $24,400 to $29,000 (16% discount to no discount from Wholesale Acquisition Cost [WAC] needed at the $150,000 threshold)

• tralokinumab: from $25,700 to $35,000 (discounts not presented due to placeholder price)

• upadacitinib: from $30,400 to $41,500 (discounts of 35% to 53% from WAC)

• dupilumab: from $29,000 to $39,500 (discounts of 6% to 31% from WAC)

“An additional consideration in comparing therapies is that many patients with atopic dermatitis have comorbid atopic conditions such as asthma, and dupilumab has proven efficacy in treating certain patients with asthma or chronic rhinosinusitis,” the report authors noted.

The ICER report explains² that step therapy is suggested, “when it provides adequate flexibility to meet the needs of diverse patients and when implementation can meet high standards of transparency and efficiency.”

Specialty society guidelines that may inform future policy regarding appropriate step therapy are being updated and expected in 2022. ICER recommends that clinical societies update their practice and treatment guidelines to make AD treatments easier to interpret by both patient and provider.

For payers specifically, ICER stated they must, “Ensure that benefit designs developed in conjunction with employers and other plan sponsors do not create requirements for out-of-pocket spending that create major barriers to appropriate access for vulnerable patients.”

Key policy recommendations³ from ICER include:

• If multiple agents for severe atopic dermatitis are approved, payers should make available at least one biologic (dupilumab and/or tralokinumab) and at least one JAK-1 inhibitor given how different these classes are in their onset of action and their risk profile.

• Payers establishing step therapy with less expensive systemic agents and/or phototherapy should allow patients and clinicians to choose from multiple options rather than require patients to try all options. 

• All stakeholders have a responsibility and an important role to play in ensuring that effective new treatment options for patients with atopic dermatitis are introduced in a way that will help reduce health inequities.

Panel members indicated other important considerations for payers, which included acuity of need based on AD severity, magnitude of lifetime impact on each patient, patients’ ability to achieve major life goals, and caregivers’ quality of life.

References:

1. Institute for Clinical and Economic Review. Report at a Glance: Atopic Dermatitis. August 2021. Accessed September 10, 2021. https://icer.org/wp-content/uploads/2020/12/atopic-dermatitis-RAAG-9AUG2021-1.pdf

2. Institute for Clinical and Economic Review. JAK inhibitors and monoclonal antibodies for the treatment of atopic dermatitis: final policy recommendations. Accessed September 10, 2021. https://icer.org/wp-content/uploads/2020/12/Atopic-Dermatitis_Policy-Recommendations.pdf

3. Institute for Clinical and Economic Review. ICER publishes final evidence report and policy recommendations on therapies for atopic dermatitis [press release]. August 17, 2021. Accessed September 10, 2021. https://icer.org/news-insights/press-releases/icer-publishes-final-evidence-report-and-policy-recommendations-on-therapies-for-atopic-dermatitis/