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Sach, Tracey H. 
ORCID: https://orcid.org/0000-0002-8098-9220, Lartey, Stella T. ORCID: https://orcid.org/0000-0001-9519-7886, Davies, Charlotte, Chalmers, Joanne R., Haines, Rachel H., Bradshaw, Lucy E., Montgomery, Alan A., Thomas, Kim S., Brown, Sara J., Ridd, Matthew J., Lawton, Sandra, Cork, Mike J., Flohr, Carsten, Mitchell, Eleanor, Swinden, Richard, Wyatt, Laura, Tarr, Stella, Davies-Jones, Susan, Jay, Nicola, Kelleher, Maeve M., Perkin, Michael R., Boyle, Robert J. and Williams, Hywel C.
and
BEEP Study Team
(2023)
Emollients for preventing atopic eczema: Cost-effectiveness analysis of the BEEP trial.
Clinical and Experimental Allergy, 53 (10).
pp. 1011-1019.
ISSN 0954-7894
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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: | 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. |
| Uncontrolled Keywords: | atopic eczema,cost-effectiveness,economic evaluation,emollients,prevention,immunology and allergy,immunology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2723 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023) Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Health Economics Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Social Sciences > Research Centres > Centre for Competition Policy |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 17 Aug 2023 14:32 |
| Last Modified: | 06 Apr 2024 14:32 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/92875 |
| DOI: | 10.1111/cea.14381 |
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