Pharmacoeconomic comparison of dupilumab and lebrikizumab for atopic dermatitis treatment in Italy: cost-per-responder analysis

BACKGROUND: A cost per responder model was developed to compare the pharmacoeconomic value of dupilumab and lebrikizumab for the treatment of moderate-to-severe atopic dermatitis (AD) in Italy. METHODS: Two indirect treatment comparisons were conducted at 16 and 52 weeks. In the 16-week analysis, dupilumab's efficacy was assessed against lebrikizumab (both with topical corticosteroids) using data from the LIBERTY AD CHRONOS and ADhere trials. The 52-week analysis, using LIBERTY AD SOLO-CONTINUE and ADvocate studies, focused on patients who achieved optimal response at 16 weeks (defined as ≥75% reduction in Eczema Area and Severity Index [EASI 75] and Investigator's Global Assessment of clear/almost clear skin score 0 or 1 [IGA 0/1]) to dupilumab or lebrikizumab. Responders were re-randomized to active treatment or placebo and followed until week 52. Treatment response was measured by EASI 75, Itch Numeric Rating Scale (I-NRS) ≥4, and IGA 0/1. The Number Needed to Treat (NNT) was calculated for each drug (vs. placebo) and multiplied by treatment cost to estimate the cost per additional responder. RESULTS: At 16 weeks, dupilumab was more effective for all endpoints. Across all comparisons, dupilumab consistently demonstrated a lower NNT than lebrikizumab and its cost per responder was always more favorable with a delta cost of at least -€24,490 (for EASI 75). At 52 weeks, dupilumab remained more favorable in all outcomes with a difference in its cost per responder vs. lebrikizumab no less than -€28,649 (for IGA 0/1). CONCLUSIONS: This study suggests that dupilumab offers greater clinical and economic benefits than lebrikizumab for AD patients, supporting its preference among healthcare decision-makers.