Sach, TH;
Lartey, ST;
Davies, C;
Chalmers, JR;
Haines, RH;
Bradshaw, LE;
Montgomery, AA;
Thomas, KS;
Brown, SJ;
Ridd, MJ;
et al.
Sach, TH; Lartey, ST; Davies, C; Chalmers, JR; Haines, RH; Bradshaw, LE; Montgomery, AA; Thomas, KS; Brown, SJ; Ridd, MJ; Lawton, S; Cork, MJ; Flohr, C; Mitchell, E; Swinden, R; Wyatt, L; Tarr, S; Davies-Jones, S; Jay, N; Kelleher, MM; Perkin, MR; Boyle, RJ; Williams, HC; BEEP Study Team
(2023)
Emollients for preventing atopic eczema: Cost-effectiveness analysis of the BEEP trial.
Clin Exp Allergy, 53 (10).
pp. 1011-1019.
ISSN 1365-2222
https://doi.org/10.1111/cea.14381
SGUL Authors: Perkin, Michael Richard
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Abstract
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.
Item Type: | Article | ||||||||||||||||||||||||
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Additional Information: | © 2023 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited. | ||||||||||||||||||||||||
Keywords: | atopic eczema, cost-effectiveness, economic evaluation, emollients, prevention, BEEP Study Team, 1107 Immunology, 1111 Nutrition and Dietetics, 1117 Public Health and Health Services, Allergy | ||||||||||||||||||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Population Health Research Institute (INPH) | ||||||||||||||||||||||||
Journal or Publication Title: | Clin Exp Allergy | ||||||||||||||||||||||||
ISSN: | 1365-2222 | ||||||||||||||||||||||||
Language: | eng | ||||||||||||||||||||||||
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Publisher License: | Creative Commons: Attribution 4.0 | ||||||||||||||||||||||||
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PubMed ID: | 37574761 | ||||||||||||||||||||||||
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URI: | https://openaccess.sgul.ac.uk/id/eprint/115642 | ||||||||||||||||||||||||
Publisher's version: | https://doi.org/10.1111/cea.14381 |
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