Aims: Hidradenitis suppurativa (HS) is a chronic skin condition causing inflammatory lesions, pain, scarring, and impaired mobility. Treatment options are limited and often lack success implying the need for additional/improved treatments. This research aimed to estimate the potential economic value of a treatment candidate, explore drivers of cost-effectiveness, and highlight economic evidence requirements for successful future value assessments.
Materials and methods: An early cost-effectiveness model was developed to assess the cost-effectiveness (cost per quality-adjusted life year (QALY) gained) of a treatment candidate compared against the only authorized biologic, adalimumab, for moderate to severe HS, from a UK National Health Service and Personal Social Service perspective. A targeted literature review of clinical and economic references and previous health technology assessments (HTA) was performed for development and validation of the early economic model used to present sensitivity analyses accompanying the base case cost-effectiveness results.
Results and limitations: Base case results revealed the candidate not to be cost-effective compared to adalimumab when considering a formal cost-effectiveness threshold of £30,000 per QALY gained. Scenario- and threshold analyses highlighted that reducing dosing or drug price by half improved the cost-effectiveness of the candidate. Cost-effectiveness was highly sensitive to health states' utility values, treatment discontinuation, and resource utilization, in line with existing HTA evidence. The paucity of economic studies and uncertainties around the candidate presented methodological constraints that were addressed through sensitivity analyses.
Conclusions: Key costs and health effects drivers were highlighted to contextualize under which circumstances a treatment candidate for moderate to severe HS would reach acceptable cost-effectiveness levels. This early economic evaluation suggested promising economic perspectives for treatment candidates in HS. Exploring novel ways to use clinical endpoints to simulate the patient pathway and clinically meaningful treatment achievements in future research will facilitate the value demonstration of candidates in disease areas with high unmet care need.
Keywords: Economic evaluation; I10; I19; acne inversa; cost-effectiveness; hidradenitis suppurativa; value assessment.