Emollients for preventing atopic eczema: Cost-effectiveness analysis of the BEEP trial

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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.
Original languageEnglish
Pages (from-to)1011-1019
Number of pages9
JournalClinical and Experimental Allergy
Volume53
Issue number10
DOIs
Publication statusPublished - 13 Aug 2023

Bibliographical note

Funding Information:
Funding for the trial was obtained from the National Institute for Health and Care Research (NIHR) Health Technology Assessment funding stream (reference 12 /67/12). Additional funding for the food allergy and sensitisation tests was obtained from Goldman Sachs Gives and the Sheffield Children's Hospital Research Fund (reference CA15008). Research nurse support was provided by the NIHR Clinical Research Networks. The trial was developed with and supported by the UK Dermatology Clinical Trials Network (UK DCTN). THS 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. SJB holds a Wellcome Trust Senior Research Fellowship in Clinical Science (reference 106865/Z/15/Z). CF held an NIHR Career Development Fellowship (CDF‐2014–07–037) during the trial and is supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. MK holds an NIHR Transitional Research Fellowship (TRF‐2017–10–003). MJR held a Post‐Doctoral Research Fellowship from NIHR (PDF‐2014–07–013). THS held a NIHR Career Development Fellowship (CDF‐2014–07–006) during part of this study. The views expressed here are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CF received a grant from the EU IMI grant scheme (Horizon 2020). His department has received investigator‐led funding for microbiome research. Both are outside of the submitted work. CF leads the European Dermatology Forum treatment guidelines for eczema. MJC received grants and personal fees from Sanofi‐Genzyme/Regeneron, Pfizer, Leo Phgroupa, L'Oreal/LaRoche Possay, Johnson & Johnson, Perrigo/ACO Nordic and grants from Galapagos, outside of the submitted work. HCW was the director of the NIHR Health Technology Assessment Programme 2015 to 2020. 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. HCW and THS had no part in the decision‐making for funding this study. All other authors declare no competing interests.

Funding Information:
The UK DCTN is grateful to the British Association of Dermatologists and the University of Nottingham for financial support of the network. We would like to thank the parents and infants who took time to participate in this trial, and the patients who contributed to trial design by providing helpful feedback at different stages of trial development. We would like to thank Sheila C Wright (Skin Research Group, Division of Molecular and Clinical Medicine, University of Dundee, UK) for cataloguing and processing the saliva samples for DNA analysis, Daniel Simpkins from the Nottingham CTU for providing the trial database and Douglas Grindlay (Centre of Evidence Based Dermatology, University of Nottingham, UK) for assistance with literature searches.

Funding Information:
This study presents independent research funded by the National Institute for Health and Care Research (NIHR) under its Health Technology Assessment programme (12/67/12). 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:
© 2023 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.

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