Ανάλυση κόστους - αποτελεσματικότητας του Dupilumab έναντι της καλύτερης υποστηρικτικής φροντίδας (Best Supportive Care) στην μέτρια έως σοβαρή ατοπική δερματίτιδα ενηλίκων
Cost - effectiveness analysis of Dupilumab versus Best Supportive Care (BSC) in the treatment of moderate to severe atopic dermatitis in adult patients
Σταθάκου, Βασιλική Χριστίνα
Atopic dermatitis or atopic eczema is a chronic skin disorder with a significant disease burden that causes intense itching in patients. The causes of its occurrence are not yet fully established and they appear to relate to a combination of factors, both genetic and environmental. The burden of atopic dermatitis is multidimensional, including the impact on quality of life, medical and psychological co-morbidity, as well as the economic cost for both patients and the health care system. Dupilumab has been recently approved in several countries including Greece as a second-line treatment for patients with moderate to severe atopic dermatitis who had previously received ciclosporin with insufficient efficacy response or showed intolerance. The cost-effectiveness of Dupilumab compared to BSC for the treatment of atopic dermatitis has not been assessed in Greece. The aim of this dissertation is to assess the medical costs associated with atopic dermatitis and to evaluate the clinical and economic benefits of dupilumab versus the best supportive care in the treatment of moderate to severe adult atopic dermatitis. The analysis used a Markov model, and it adopted the perspective of the Greek health system, over a lifetime horizon. Given the lack of primary data, the data used to populate the model was drawn from the literature. The assessment of the treatment’s effectiveness was based on the results of the LIBERTY AD study and in particular the CHRONOS clinical trial. The effectiveness as used in the model was measured in QALYs, as first this is considered the preferred measure of intervention effectiveness and second the intervention under evaluation has been shown not to affect life expectancy. The costs were calculated based on the use of medical resources as recorded in the literature and on expert opinion provided by a specialist dermatologist. Dupilumab resulted in higher costs per patient, while it also increased the number of QALYs. The ICER was found to be € 349,578 per QALY gained over the lifetime of the patients. Sensitivity analysis has shown that the results are sensitive to the drug price. Based on the resultant ICER, treatment with Dupilumab would not be considered cost xiv effective for the Greek health system and a significant reduction in the price of dupilumab should occur for the treatment with dupilumab to be considered a costeffective option by most decision-makers in the Greek health care setting.