(240) Estimating the Economic Impact of Dupilumab in Type 2 Inflammatory Disease: Cost Offset Analysis of Atopic Dermatitis with Comorbid Asthma in the US Healthcare System

Background: : In the “atopic march,” atopic diseases (e.g. asthma) driven by Type 2 (T2) inflammation follow a diagnosis of atopic dermatitis (AD). Dupilumab, an approved treatment for moderate-to-severe AD and asthma, has been associated with a reduced risk of atopic march progression including asthma in pediatric patients with AD.

Objective: : To evaluate the expected cost-offsets of dupilumab relative to conventional therapies in pediatric patients with AD in preventing and treating the development of asthma.

Methods: : A cost-offset model with a 5-year time horizon was developed from the US payer perspective, based on 1 million health plan members. The model assumed 4% of pediatric patients have AD with comorbid severe asthma (SA), and 4.8% have AD and will develop asthma. Pediatric patients with moderate-to-severe AD (N=2,856; mean age: 8 years) prescribed either dupilumab or conventional therapies entered the model. All patients were assumed to receive one or the other treatment. Total yearly costs (2024 USD; direct healthcare costs: inpatient/hospitalization, outpatient, emergency room, and pharmacy costs related to AD and asthma), along with asthma cases and healthcare resource utilization (HCRU) for AD and asthma were based on published real-world progression data. The cost of dupilumab was not included. The number of patients expected to have AD was based on epidemiological data. Treatment effects for treating comorbid SA were based on dupilumab clinical trials. Economic data and the relative risk of dupilumab in reducing future SA cases in patients with AD (hazard ratio=0.600) were derived from published studies. One-way sensitivity analyses were conducted with varying HCRU costs, and efficacy data.

Results: : Total yearly costs, years 1 through 5, were consistently lower for dupilumab vs. conventional therapies, as were cumulative 5-year total costs ($366.26M vs $405.53M; 10% reduction) and prevalent asthma-related costs ($13.87M vs $17.95M; 23% reduction). Additionally, asthma cases were lower with dupilumab over 5 years (109 vs 142; 23% reduction), resulting in reduced future incident asthma costs from onset (dupilumab vs conventional therapies: $12.90M vs $19.74M; 35% reduction). HCRU claims were reduced by >30% with dupilumab, as well as for cumulative HCRU claims (157,114 vs 293,411; 46% reduction).

Conclusions: : Our model estimated that dupilumab, a Type-2 targeted therapy, potentially reduces costs and HCRU related to prevalent and future incident asthma compared to conventional therapies in pediatric patients with AD.

Sponsorship:: Sanofi and Regeneron.