Economic impact of abrocitinib monotherapy and combination therapy in patients with moderate-to-severe atopic dermatitis: Results from JADE MONO-2 and JADE COMPARE

To the Editor: Atopic dermatitis (AD) places a substantial financial burden on patients and society.1Drucker A.M. Wang A.R. Li W.Q. Sevetson E. Block J.K. Qureshi A.A. The burden of atopic dermatitis: summary of a report for the National Eczema Association.J Invest Dermatol. 2017; 137: 26-30Abstract Full Text Full Text PDF PubMed Scopus (236) Google Scholar Abrocitinib, a once-daily oral selective Janus kinase 1 inhibitor in development for moderate-to-severe AD, was effective and well tolerated in patients with moderate-to-severe AD as monotherapy (JADE MONO-2 [NCT03575871])2Silverberg J.I. Simpson E.L. Thyssen J.P. et al.Efficacy and safety of abrocitinib in patients with moderate-to-severe atopic dermatitis: a randomized clinical trial.JAMA Dermatol. 2020; 156: 863-873Crossref PubMed Scopus (84) Google Scholar or in combination with topical therapy (JADE COMPARE [NCT037204700]).3Thaci T, Bieber T, Simpson EL, et al. A phase 3 study to investigate the efficacy and safety of abrocitinib and dupilumab in comparison with placebo in adults with moderate-to-severe atopic dermatitis. Paper presented at: 29th EADV Congress (Virtual); October 28-November 1, 2020. Poster P0207.Google Scholar However, the economic impact of abrocitinib in terms of direct health care costs and indirect costs remains unknown. This preliminary post hoc economic analysis examined short-term direct and indirect cost reductions, from health care payer and societal perspectives, respectively, associated with abrocitinib (200 mg and 100 mg) treatment versus dupilumab or placebo in patients with moderate-to-severe AD. Outcomes included the number of physician visits in the past 3 months from JADE COMPARE and the overall work impairment (ie, absenteeism and presenteeism measured using the Work Productivity and Activity Impairment Questionnaire: Atopic Dermatitis, Version 2.0) from JADE MONO-2. Physician cost savings (annualized, mean per patient) were based on the reduction in physician visit frequency from baseline to week 16 multiplied by the physician visit unit cost ($265 [2016]).4Machlin S.R. Mitchell E.M. Statistical brief #517: expenses for office-based physician visits by specialty and insurance type, 2016. Agency for Healthcare Research and Quality, 2018https://meps.ahrq.gov/data_files/publications/st517/stat517.shtmlDate accessed: February 8, 2021Google Scholar Indirect cost savings were estimated based on the reduction in the overall work impairment1Drucker A.M. Wang A.R. Li W.Q. Sevetson E. Block J.K. Qureshi A.A. The burden of atopic dermatitis: summary of a report for the National Eczema Association.J Invest Dermatol. 2017; 137: 26-30Abstract Full Text Full Text PDF PubMed Scopus (236) Google Scholar from baseline to week 12 and multiplied by the annual median wage in the United States ($49,348 [the first quarter of 2020]).5US Bureau of Labor Statistics Usual weekly earnings of wage and salary workers. First quarter 2020. US Department of Labor, 2020https://www.bls.gov/news.release/pdf/wkyeng.pdfDate accessed: February 8, 2021Google Scholar The demographic and baseline characteristics were similar among the patients in JADE COMPARE (n = 837)3Thaci T, Bieber T, Simpson EL, et al. A phase 3 study to investigate the efficacy and safety of abrocitinib and dupilumab in comparison with placebo in adults with moderate-to-severe atopic dermatitis. Paper presented at: 29th EADV Congress (Virtual); October 28-November 1, 2020. Poster P0207.Google Scholar and JADE MONO-2 (n = 391).2Silverberg J.I. Simpson E.L. Thyssen J.P. et al.Efficacy and safety of abrocitinib in patients with moderate-to-severe atopic dermatitis: a randomized clinical trial.JAMA Dermatol. 2020; 156: 863-873Crossref PubMed Scopus (84) Google Scholar Of the included patients, 720 in JADE COMPARE (abrocitinib 200 mg, n = 196; abrocitinib 100 mg, n = 204; dupilumab injection 300 mg, n = 211; and placebo, n = 109) had physician visit data, and 347 patients in JADE MONO-2 (abrocitinib 200 mg, n = 138; abrocitinib 100 mg, n = 139; and placebo, n = 70) completed the Work Productivity and Activity Impairment-AD questionnaires. The patients treated with abrocitinib (200 mg and 100 mg), dupilumab, or placebo in JADE COMPARE reported similar decreases in the mean number of physician visits from the baseline (mean [SD], 2.8 [3.4], 3.0 [5.0], 2.8 [3.1], and 3.0 [3.4], respectively) to week 16 (mean [SD], 0.9 [2.3], 1.0 [2.3], 1.3 [2.8], and 1.6 [2.6], respectively; Table I). The patients treated with abrocitinib (200 mg or 100 mg) in JADE MONO-2 reported a greater reduction in overall work impairment at week 12 versus placebo (least squares mean change from baseline [95% CI], −22.9 [−28.2, −17.6] or −18.7 [−23.4, −14.0] versus −5.0 [−12.8, 2.8], respectively; Fig 1). The estimated annualized indirect/direct (total) cost reductions from baseline in patients who received abrocitinib 200 mg or abrocitinib 100 mg versus placebo were $11,301/$1636 ($12,937) and $9228/$1723 ($10,951), respectively.Table IPhysician visits in JADE COMPARE at week 16Study periodAbrocitinib200 mg QD n = 226Abrocitinib100 mg QD n = 238Dupilumab300 mg Q2W n = 242Placebo n = 131Baseline n224237236129 Mean (SD)2.8 (3.4)3.0 (5.0)2.8 (3.1)3.0 (3.4)Week 16 n196204211109 Mean (SD)0.9 (2.3)1.0 (2.3)1.3 (2.8)1.6 (2.6)Allowed medicated topical therapies included low- or medium-potency topical corticosteroids, topical calcineurin inhibitors, and topical phosphodiesterase-4 inhibitors.QD, Once daily; Q2W, every 2 weeks; SD, standard deviation. Open table in a new tab Allowed medicated topical therapies included low- or medium-potency topical corticosteroids, topical calcineurin inhibitors, and topical phosphodiesterase-4 inhibitors. QD, Once daily; Q2W, every 2 weeks; SD, standard deviation. This preliminary economic analysis suggests that, although all patients in JADE COMPARE reported a similar decrease in physician visits, abrocitinib (200 mg and 100 mg) was associated with greater improvements in overall work impairment and associated costs versus placebo, as demonstrated in JADE MONO-2. The limitations of this economic analysis include not accounting for other health care costs and the extrapolation from short-term periods to annual costs, particularly since treatment nonresponders would likely be switched to another therapy in a real-world setting (thus, potentially improving their outcomes over the course of a full year). Future claims analyses can address these limitations; however, these findings represent a preliminary assessment of whether abrocitinib might provide a meaningful improvement in economic outcomes. Dr Gooderham has received grants, personal fees, honoraria, and/or nonfinancial support from Pfizer Inc , AbbVie , Amgen , Akros Pharma , Arcutis , Bristol Myers Squibb , Boehringer Ingelheim , Celgene , Dermira , Dermavant , Eli Lilly , Galderma , Janssen , Kyowa Kirin , LEO Pharma , MedImmune , Merck , Novartis , Roche , Sanofi Genzyme , Regeneron , Sun Pharma , UCB , and Bausch Health ( Valeant ). Dr Chu is an investigator for Pfizer Inc, AbbVie, Dermira, Eli Lilly, Novartis, Oneness Biotech, Regeneron, Roche, and Sanofi; a consultant for Pfizer Inc, AbbVie, Eli Lilly, Novartis, Roche, and Sanofi; a speaker for Pfizer Inc, AbbVie, Eli Lilly, Mylan, Novartis, Roche, and Sanofi; and is on advisory boards for Pfizer Inc, Mylan, Roche, and Sanofi. Drs Rojo, Valdez, Biswas, Cameron, Feeney, Encinas, Peeples-Lamirande, Cappelleri, and DiBonaventura and Ms Myers are employees and stockholders of Pfizer Inc. Editorial/medical writing support under the guidance of the authors was provided by Susanna Bae, PharmD (ApotheCom, San Francisco, CA), and Gauri Saal, MA Economics (ApotheCom, London, United Kingdom). It was funded by Pfizer Inc, New York, NY, in accordance with the Good Publication Practice (GPP3) guidelines (Ann Intern Med. 2015;163:461-464).

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