OBJECTIVES: To assess the cost-effectiveness of 1.5% ruxolitinib cream for the treatment of atopic dermatitis (AD) in patients aged ≥12 years whose disease is not adequately controlled with conventional topical prescription therapies or when those therapies are not advisable, from the Canadian healthcare payer perspective.

METHODS: A semi-Markov model was developed with 4-week cycles and a lifetime horizon. The model allowed up to two lines of treatment, with induction and maintenance phases, and a final line of best supportive care (BSc). Response was based on Investigator’s Global Assessment (IGA) 0/1 and was assessed following induction. Responders entered the maintenance state until discontinuation due to lack of efficacy or adverse events (AEs). Non-responders transitioned to a subsequent therapy (biologic, oral Janus kinase inhibitor) or directly to BSc. Transition to death from any state was informed by general population mortality. Efficacy for the reference case (intent-to-treat population) was informed by the TRuE-AD1 and TRuE-AD2 studies, and a network meta-analysis informed efficacy for subsequent treatments and comparators among patients with a more severe subset of moderate AD (defined as IGA 3, Eczema Area and Severity Index ≥16, body surface area ≥10%). Drug acquisition, administration, healthcare resource utilization, and AE costs were included. Health-state utility values were informed by the TRuE-AD studies.

RESULTS: In the reference case, 1.5% ruxolitinib cream was more effective (+0.93 quality-adjusted life-years) and was associated with lower costs (–CAD$5295.41) compared with vehicle, indicating that 1.5% ruxolitinib cream was the dominant treatment option. In the scenario analysis of patients with a more severe subset of moderate AD, 1.5% ruxolitinib cream was the dominant treatment option when compared with dupilumab and upadacitinib.

CONCLUSIONS: Results suggest that 1.5% ruxolitinib cream is a highly cost-effective option for the treatment of patients aged ≥12 years with mild-to-moderate AD, including patients with more extensive disease.