Impatto economico-organizzativo della gestione con dupilumab dei soggetti affetti da dermatite atopica grave in Italia

OBJECTIVE The study describes the economic and organi- sational impact for the NHS of the pathway of an adult patient with severe atopic dermatitis, with inadequate response or contraindications/intol- erances to cyclosporine, treated with dupilumab. METHODOLOGY The analysis is based on the available literature on the efficacy and safety of using dupilumab for the treatment of individuals with severe atopic dermatitis and the pathway in terms of prepa- ratory activity prior to initiation of drug therapy, monitoring activity following initiation of thera- py, management of adverse events and duration of treatment. Consistency with actual clinical practice was verified through the administration of semi-structured interviews with four experts. The economic evaluation of the pathway (NHS perspective) considered direct medical costs (year 2024). RESULTS The pathway analysed ranges from the initia- tion of treatment with dupilumab to a potential switch to an oral JAK inhibitor in the medium to long term. For dupilumab, no organisational im- pact emerges: the annual cost of monitoring is nil, while the average cost of managing adverse events ranges from € 1.2 to € 63.9 per patient. In the scenario in which patients switch to a JAK inhibitor, monitoring costs include € 81.61 per pa- tient for mandatory initial monitoring and € 57.63 per year once therapy starts. The annual cost of adverse events management ranges from € 17.0 to € 427.8 per patient. The marketing authorisa- tion in the “A-PHT” classification envisages pos- sible optimisation for patients in the withdrawal of the drug by increasing the ease of supply. CONCLUSIONS Dupilumab has a negligible economic and or- ganisational impact on the NHS by not requiring diagnostic and laboratory tests for the initiation of treatment, nor drug-specific monitoring ac- tivities, except for routine disease monitoring, unlike other treatments, such as oral JAK inhib- itors. This makes dupilumab significantly less burdensome for the NHS, especially in a context of long waiting lists. The dual distribution chan- nel promotes accessibility for patients and re- duces the burden on hospital resources.