Tralokinumab as a cost-saving treatment option for adults and adolescents with moderate-to-severe atopic dermatitis enrolled in US health insurance plans: a budget impact analysis

Background: Atopic dermatitis (AD) is a chronic and burdensome condition that causes intense itching and painful skin lesions and affects around 10% of adults and adolescents across the US. Potent systemic treatments, such as tralokinumab, are needed to treat patients with moderate-to-severe disease who have experienced inadequate symptom control using topical therapies. Novel systemic treatments can not only provide effective relief for these patients but can also be cost saving. Aim: To evaluate the budgetary implications of tralokinumab as a treatment for moderate-to-severe AD in a hypothetical US commercial healthcare plan with 1 million (M) members. Materials & methods: A budget impact model was developed to estimate the difference in total systemic treatment costs between two scenarios: one in which dupilumab, lebrikizumab, nemolizumab, abrocitinib and upadacitinib are assumed to be the only treatments available, and one in which tralokinumab is assumed to be an additional option. The analysis took the perspective of a US commercial payer and estimated total treatment costs over a 3-year time horizon. Patients were distributed to treatments based on forecasted market share data and could switch from dupilumab to other systemic treatments in the model at any time. Switching rates were also informed using forecasting data. Adult patients receiving tralokinumab and adults or adolescents receiving lebrikizumab and nemolizumab could switch to a lower frequency administration schedule if they achieved clear or almost clear skin, reducing the number of doses received and consequently the treatment costs. Treatment costs were informed by 2025 wholesale acquisition costs. Results: Total costs when tralokinumab was not available were estimated to be $21.0 M, $27.7 M and $35.9 M in years 1–3, respectively. When tralokinumab was available, estimates were $20.6 M (Δ-0.5 M) in year 1, $26.6 M (Δ-1.1 M) in year 2 and $34.1 M (Δ-1.8 M) in year 3. Therefore, availability of tralokinumab led to cumulative cost savings of $3.4 M across all 3 years ($2.3 M in adults and $1.1 M in adolescents). Cumulative treatment costs per plan member at year 3 also reduced from $84.68 to $81.26 (Δ-3.42) due to tralokinumab. Lastly, cumulative per patient treatment costs across the 653 patients estimated to receive systematic therapy over the 3 years reduced from $129,794 to $124,556 when tralokinumab was available. Conclusion: Tralokinumab is a cost-saving therapy when used for the treatment of moderate-to-severe AD in both adult and adolescent populations, with cost savings driven by competitive skin clearance rates, low monthly treatment costs and flexible dosing options in adults (i.e., Q2W → Q4W).