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Published on: September 26, 2019
Cost-effectiveness of Prophylactic Moisturization for Atopic Dermatitis
Shuai Xu1, Supriya Immaneni1, Gordon B Hazen2
1Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Daily moisturization for infants may prevent atopic dermatitis. This cost-effectiveness study found petrolatum to be the most economical option, offering significant quality-adjusted life-year (QALY) benefits.
Area of Science:
- Dermatology
- Pediatrics
- Health Economics
Background:
- Atopic dermatitis (AD) is a common skin condition in infants.
- Emerging evidence suggests prophylactic moisturization may prevent AD development in newborns and infants (0-6 months).
- AD poses a significant health expenditure and is linked to comorbidities.
Purpose of the Study:
- To evaluate the cost-effectiveness of daily total-body moisturization for preventing atopic dermatitis in high-risk newborns.
- To determine the most cost-effective prophylactic moisturizing agent for infants.
Main Methods:
- A cost-effectiveness analysis was performed on 7 common moisturizers for infants from birth to 6 months.
- Calculated costs based on average daily moisturizer usage and price per ounce.
- Estimated incremental gain in quality-adjusted life-years (QALYs) over a 6-month period, assuming a 50% relative risk reduction for AD.
- Conducted a sensitivity analysis varying relative risk from 0.28 to 0.90.
Main Results:
- Average daily moisturizer use ranged from 3.6 g at birth to 6.6 g at 6 months.
- The average incremental QALY benefit was 0.021 over 6 months.
- Petrolatum was the most cost-effective moisturizer at $353 per QALY.
- Even the most expensive moisturizers were below the $45,000/QALY threshold.
Conclusions:
- Daily prophylactic moisturization is a potentially cost-effective strategy to reduce the burden of atopic dermatitis in infants.
- Petrolatum demonstrates the best cost-effectiveness among the evaluated moisturizers for AD prevention.
- Implementing preventative moisturization can mitigate healthcare costs associated with atopic dermatitis.
Importance:
Emerging evidence suggests that the use of moisturizers on newborns and infants (ie, from birth to 6 months of age) is potentially helpful in preventing the development of atopic dermatitis.
Objective:
To investigate the cost-effectiveness of using a daily moisturizer as prevention against atopic dermatitis among high-risk newborns.
Design, Setting, And Participants:
In a cost-effectiveness analysis, the average cost of total-body moisturization using 7 common moisturizers from birth to 6 months of age was determined for male and female infants. We assumed the same unit of weight per moisturizer used for a given body surface area. Based on previously reported data (relative risk reduction of 50%), the incremental gain in quality-adjusted life-years (QALYs) was determined using a 6-month time window. The cost-effectiveness of each moisturizer was determined by assuming equal efficacy. A sensitivity analysis was conducted by varying the relative risk from 0.28 to 0.90.
Interventions:
Use of prophylactic moisturizing compounds.
Main Outcomes And Measures:
The primary outcomes were the incremental cost-effectiveness values ($/QALY) for each moisturizer in preventing atopic dermatitis during a 6-month time window.
Results:
The calculated amount of daily all-body moisturizer needed at birth was 3.6 g (0.12 oz) per application, which increased to 6.6 g (0.22 oz) at 6 months of age. Of the 7 products evaluated, the average price was $1.07/oz (range, $0.13/oz-$2.96/oz). For a 6-month time window, the average incremental QALY benefit was 0.021. The sensitivity analysis showed that the incremental gain of QALY ranged from 0.0041 to 0.030. Petrolatum was the most cost-effective ($353/QALY [95% CI, $244-$1769/QALY) moisturizer in the cohort. Even assuming the lowest incremental QALYs for the most expensive moisturizer, the intervention was still less than $45 000/QALY.
Conclusions And Relevance:
Overall, atopic dermatitis represents a major health expenditure and has been associated with multiple comorbidities. Daily moisturization may represent a cost-effective, preventative strategy to reduce the burden of atopic dermatitis.
