OBJECTIVES: This structured literature review aims to investigate economic models assessing the cost-effectiveness of atopic dermatitis (AD) treatments, focusing on the approaches and methodological challenges inherent in economic modeling for topical treatments.

METHODS: Searches were conducted across select health technology assessment (HTA) body websites including Canada, UK, USA, France, and Australia, up to November 2023. HTA evaluations for topical and systemic/biologic therapies in AD were included. Critical features of model design, data inputs, assumptions and limitations were analyzed.

RESULTS: The review identified only 3 HTA reviews for topical treatments between years 2004 and 2018, compared with 11 HTA reviews for systemic/biologic therapies between years 2018 and 2022. Economic evaluations utilized various approaches, including cost-effectiveness (which included Markov microsimulation and semi-Markov), disease-controlled days analysis, and cost minimization. Key modeling limitations highlighted by HTAs included accurately representing the chronic nature of AD due to complex health states such as intermittent acute flare-ups, and severity progression. Other challenges included choosing an appropriate time horizon and including the relevant comparators due to overlapping severity indications. Topical treatments have additional challenges such as validating indirect comparative efficacy and safety data, attributed to variations in baseline risk and response rates to vehicles. Additionally, estimating treatment cost and utilization for topicals in analyses is challenging due to calculative assumptions.

CONCLUSIONS: This review highlights the paucity of economic models and evaluations of topical treatments for AD compared with systemic/biologics. There is a clear need for a more nuanced focus on the economic assessment of topical treatments due to the number of innovative topical therapies being investigated for reimbursement in AD. Future economic analyses should prioritize these gaps to enhance the quality and relevance of health economic assessments in the context of AD topical treatments.