Defense Date


Document Type



Pharmaceutical Sciences

First Advisor

David A Holdford


Objective: This study evaluated the budget impact of introducing upadacitinib for patients with uncontrolled moderate-to-severe atopic dermatitis (AD) from a United States (U.S.) private payer perspective.

Methods: The model estimated costs before and after the adoption of upadacitinib for a hypothetical one million covered lives over 3 years. The model included immunosuppressant agents and dupilumab. Market uptake was assumed to be 2% per year. Treatments incur a cost for drug acquisition, and the costs associated with drug administration, laboratory testing, and clinic visits. The model calculated the impact on the budget in 2022 U.S. dollars. Various assumptions on market uptake were analyzed, and a sensitivity analysis was performed.

Results: For one million covered lives with an estimated 3607 people receiving immunosuppressant agents or dupilumab, the total cost after introducing upadacitinib increased by $3.5, $7.0, and $10.5 million in years 1–3, respectively, resulting in a cumulative increase of $21.1 million over 3 years. The incremental per member per year costs were $3.52, $7.04, and $10.59 in years 1–3, respectively, resulting in an increase in per member per month costs of $0.29 in year 1, $0.59 in year 2, and $0.88 in year 3. The incremental per treated member per month costs were $70.77, $140.72, and $210.67 in years 1–3, respectively. Scenario and sensitivity analyses confirmed the model robustness.

Conclusions: The introduction of upadacitinib had a high impact on the U.S. private payer budget. The use of upadacitinib may increase the cost of treating patients with uncontrolled moderate-to-severe AD.


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