Cost-Effectiveness of Dupilumab in the Treatment of Moderate-to-Severe Prurigo Nodularis in France

OBJECTIVES: Dupilumab is the only biologic approved to treat adults with moderate-to-severe prurigo nodularis (MS-PN) who are uncontrolled with topicals. PN is a subtype of chronic pruritus, characterized by an intense itch and pruriginous lesions. The presented approach highlights the value of dupilumab based on effectiveness related to response-year (ry) gained. The objective of the study was to perform a cost-effectiveness analysis of dupilumab to treat MS-PN versus best supportive care (BSC), from a French societal National Health perspective.

METHODS: A 24-week decision tree combined with a three-state Markov model was designed with 12-week transition and half-cycle correction to represent the pathway of patients with MS-PN treated with dupilumab compared to those receiving BSC, according to the Phase-3 PRIME (NCT04183335) and PRIME2 (NCT04202679) trials. The response to treatment was defined as a minimum improvement of 4 points on the worst-itch numerical rating scale. (WI-NRS, ranges from 0 = ‘no itch’ to 10 = ‘worst itching imaginable’). Costs and healthcare resource utilization were informed by a survey of French patients with PN, with a 2.5% discount rate for costs. Cost distribution among health states assumed that treatment responders would utilize healthcare resources similarly to patients with mild PN, and non-responders to patients with MS-PN. Sensitivity analysis explored different scenarios. The model structure was validated by the French Health Authority (HAS).

RESULTS: In the base case analysis, over a 20-year time horizon, the treatment with dupilumab versus BSC resulted in a gain of 5 incremental response-year and an incremental cost of €103,000; yielding an ICER (Incremental Cost-effectiveness Ratio) of 20,623 €/ry.

CONCLUSIONS: Dupilumab showed a significantly greater response-year gain in patients with MS-PN versus BSC. In comparison to atopic dermatitis, another dermatologic indication of dupilumab reimbursed in France, the ICER/ry is comparable in MS-PN, demonstrating a similar cost-effectiveness of dupilumab in PN.