Cost-effectiveness of two online interventions supporting self-care for eczema for parents/carers and young people

Tracey H Sach*, Mary Onoja, Holly Clarke, Miriam Santer, Ingrid Muller, Taeko Becque, Beth Stuart, Julie Hooper, Mary Steele, Sylvia Wilczynska, Matthew J Ridd, Amanda Roberts , Amina Ahmed, Lucy Yardley, Paul Little, Kate Greenwell, Katy Sivyer, Jacqui Nuttall, Gareth Grifths, Sandra LawtonSinéad M. Langan, Laura Howells, Paul Leighton, Hywel C Williams, Kim S Thomas

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review


Objective: To estimate the cost-effectiveness of online behavioral interventions ( designed tosupport eczema self-care management for parents/carers and young people from an NHS perspective.

Methods: Two within-trial economic evaluations, using regression-based approaches, adjusting for baseline and pre-specifed confounder variables, were undertaken alongside two independent, pragmatic, parallel group, unmasked randomized controlled trials, recruiting through primary care. Trial 1 recruited 340 parents/carers of children aged 0–12 years and Trial 2 337 young people aged 13–25 years with eczema scored≥5 on Patient-Oriented Eczema Measure (POEM). Participants were randomized (1:1) to online intervention plus usual care or usual care alone. Resource use, collected via medical notes review, was valued using published unit costs in UK £Sterling 2021. Quality-of-life was elicited using proxy CHU-9D in Trial 1 and self-report EQ-5D-5L in Trial 2.

Results: The intervention was dominant (cost saving and more effective) with a high probability of cost-effectiveness (>68%) in most analyses. The exception was the complete case cost–utility analysis for Trial 1 (omitting participants with children aged<2), with adjusted incremental cost savings of -£34.15 (95% CI – 104.54 to 36.24) and incremental QALYs of – 0.003 (95% CI – 0.021 to 0.015) producing an incremental cost per QALY of £12,466. In the secondary combined (Trials 1 and 2) cost-effectiveness analysis, the adjusted incremental cost was -£20.35 (95% CI – 55.41 to 14.70) with incremental success (≥2-point change on POEM) of 10.3% (95% CI 2.3–18.1%).

Conclusion: The free at point of use online eczema self-management intervention was low cost to run and cost-effective.

Trial registration This trial was registered prospectively with the ISRCTN registry (ISRCTN79282252). URL
Original languageEnglish
Number of pages12
JournalEuropean Journal of Health Economics
Early online date9 Jan 2024
Publication statusE-pub ahead of print - 9 Jan 2024

Bibliographical note

Funding Information:
All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization other than the National Institute for Health and Care Research for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work, other than LH has received consultancy fees from the University of Oxford on an educational grant funded by Pfizer, unrelated to the submitted work. THS was a member of NIHR HTA Efficient Study Designs—2, HTA Efficient Study Designs Board, HTA End of Life Care and Add-on-Studies, HTA Primary Care Themed Call Board and the HTA Commissioning Board between 2013 and Dec 2019. She is a steering committee member of the UK Dermatology Clinical Trials Network and Chair of the NIHR Research for Patient Benefit Regional Advisory Panel for the East of England. THS had no part in the decision-making for funding this study.

Funding Information:
This study presents independent research funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research programme (grant ref No RP-PG-0216–20007). Eczema Care Online (ECO) interventions were developed using LifeGuide software, which was partly funded by the NIHR Southampton Biomedical Research Centre (BRC). SiL was supported by a Wellcome senior research fellowship in clinical science (205039/Z/16/Z). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2024, The Author(s).


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