The Cost-Effectiveness and Budget Impact Analysis of Upadacitinib for Moderate-to-Severe Atopic Dermatitis in Saudi Arabia

Objective: Atopic dermatitis (AD) is a prevalent dermatological disease in Saudi Arabia. This study aimed to estimate the cost-effectiveness and budget impact of upadacitinib in adults and adolescents with moderate-to-severe AD in Saudi Arabia. Methods: A 1-year decision tree model followed by a lifetime Markov model was developed to estimate the cost-effectiveness of upadacitinib compared to dupilumab and other novel AD treatments in moderate-to-severe AD patients aged ≥ 12 years in Saudi Arabia from the public payer perspective. In addition, we developed a 5-year budget impact model to estimate the financial consequences of increasing the market share of upadacitinib. Probabilistic and deterministic sensitivity analyses were conducted to test the model’s robustness. Results: Over a lifetime horizon, upadacitinib 15 mg was associated with 0.21 additional quality-adjusted life years (QALYs) and lower costs by 148,068 SAR (39,484 USD) compared with dupilumab 300 mg. The net monetary benefit of upadacitinib 15 mg versus dupilumab 300 mg was 158,656 SAR (42,308 USD). For the budget impact, increasing the market share of upadacitinib over 5 years was associated with estimated savings of 1.5 billion SAR (412 million USD). Sensitivity analyses results supported the direction of the base-case findings. Conclusion: Upadacitinib may be a cost-effective treatment for moderate-to-severe AD in Saudi Arabia. Increasing its market share could be considered for the target population and may reduce public healthcare costs over 5 years. However, these model-based estimates should be interpreted with uncertainty due to input assumptions and local data limitations.