OBJECTIVES: Dupilumab and tralokinumab are two biologics approved for the treatment of moderate-to-severe atopic dermatitis (AD) in England. The current analysis compared the number needed to treat (NNT) and the costs/additional responder in adult patients with moderate-to-severe AD treated with dupilumab and tralokinumab, from the England’s National Healthcare Service (NHS) perspective.

METHODS: Using a recently published comparative efficacy data from Silverberg et al., 2021 on systemic therapies used in AD, an Excel-based cost calculator was developed to estimate the NNT to achieve one responder after a 16-week treatment (NHS timeline for stopping rule) with dupilumab versus tralokinumab and estimate the incremental costs/additional responder for both treatments. Response to treatment was defined as a 75% reduction from baseline in Eczema Area and Severity Index (EASI-75) or an Investigator’s Global Assessment score of 0 or 1 (IGA 0/1) at Week 16. NNT was calculated as the inverse of the absolute risk reduction versus standard of care for each biologic. Current England list prices of £1265 and £1070 per pack was used respectively for dupilumab and tralokinumab. Sensitivity analyses was done based on the drug price variation for tralokinumab.

RESULTS: The NNT to achieve one additional responder is lower with dupilumab versus tralokinumab considering both EASI-75 and IGA0/1 endpoints (3 versus 4 and 4 versus 7, respectively). The costs/additional responder for EASI-75 was higher for tralokinumab versus dupilumab (£17,100 vs. £15,200). Similar trends in costs/additional responder was observed for IGA 0/1 (£30,000 vs. £20,200). These results were robust in the sensitivity analyses.

CONCLUSIONS: Dupilumab had a lower NNT and costs/additional responder versus tralokinumab in patients with moderate-to-severe AD even with a list price of 15% higher than tralokinumab. Between both biologic treatments, dupilumab shows the best value proposition for patients and England’s NHS.