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Emollients for preventing atopic eczema: Cost-effectiveness analysis of the BEEP trial
Tracey H Sach1, Stella T Lartey1, Charlotte Davies2
1Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
Insights
Daily emollient application in infancy for eczema prevention in high-risk infants is not cost-effective. The BEEP trial found no significant reduction in eczema incidence or improvement in quality-adjusted life years (QALYs) to justify the costs.
Area of Science:
- Dermatology
- Pediatrics
- Health Economics
Background:
- Emerging evidence suggests enhancing the skin barrier from birth may prevent eczema and food allergies.
- Proactive skin barrier enhancement is a potential strategy for early-life atopic disease prevention.
Purpose of the Study:
- To evaluate the cost-effectiveness of daily full-body emollient application during the first year of life for preventing atopic eczema in high-risk children.
- To analyze health service costs and quality-adjusted life years (QALYs) over a 2-year and 5-year period.
Main Methods:
- A within-trial economic evaluation was conducted using data from the BEEP trial.
- 1394 high-risk infants were randomized to receive daily emollient application or usual care.
- Cost-effectiveness was measured by the incremental cost-effectiveness ratio (ICER) per percentage decrease in eczema risk and per QALY gained.
Main Results:
- At 2 years, the adjusted incremental cost per participant was £87.45, with a small, non-significant increase in the proportion of children without eczema.
- The ICER was £5337 per percentage decrease in eczema risk; QALYs showed minimal improvement.
- At 5 years, the emollient group had lower costs but a non-significant decrease in eczema-free proportion, with an ICER of £3201.
Conclusions:
- Daily emollient application during infancy for eczema prevention in high-risk children, as advised in the BEEP trial, does not appear to be cost-effective.
- The findings suggest that current strategies for proactive skin barrier enhancement may not offer a favorable health economic return for eczema prevention.
Background:
Recent discoveries have led to the suggestion that enhancing skin barrier from birth might prevent eczema and food allergy.
Objective:
To determine the cost-effectiveness of daily all-over-body application of emollient during the first year of life for preventing atopic eczema in high-risk children at 2 years from a health service perspective. We also considered a 5-year time horizon as a sensitivity analysis.
Methods:
A within-trial economic evaluation using data on health resource use and quality of life captured as part of the BEEP trial alongside the trial data. Parents/carers of 1394 infants born to families at high risk of atopic disease were randomised 1:1 to the emollient group, which were advised to apply emollient (Doublebase Gel or Diprobase Cream) to their child at least once daily to the whole body during the first year of life or usual care. Both groups received advice on general skin care. The main economic outcomes were incremental cost-effectiveness ratio (ICER), defined as incremental cost per percentage decrease in risk of eczema in the primary cost-effectiveness analysis. Secondary analysis, undertaken as a cost-utility analysis, reports incremental cost per Quality-Adjusted Life Year (QALY) where child utility was elicited using the proxy CHU-9D at 2 years.
Results:
At 2 years, the adjusted incremental cost was £87.45 (95% CI -54.31, 229.27) per participant, whilst the adjusted proportion without eczema was 0.0164 (95% CI -0.0329, 0.0656). The ICER was £5337 per percentage decrease in risk of eczema. Adjusted incremental QALYs were very slightly improved in the emollient group, 0.0010 (95% CI -0.0069, 0.0089). At 5 years, adjusted incremental costs were lower for the emollient group, -£106.89 (95% CI -354.66, 140.88) and the proportion without eczema was -0.0329 (95% CI -0.0659, 0.0002). The 5-year ICER was £3201 per percentage decrease in risk of eczema. However, when inpatient costs due to wheezing were excluded, incremental costs were lower and incremental effects greater in the usual care group.
Conclusions:
In line with effectiveness endpoints, advice given in the BEEP trial to apply daily emollient during infancy for eczema prevention in high-risk children does not appear cost-effective.
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