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ToolsPyne, Sarah, Sach, Tracey H., Lawrence, Megan, Renz, Susanne, Eminton, Zina, Stuart, Beth, Thomas, Kim S., Francis, Nick, Soulsby, Irene, Thomas, Karen, Permyakova, Natalia V., Ridd, Matthew J., Little, Paul, Muller, Ingrid, Nuttall, Jacqui, Griffiths, Gareth, Layton, Alison M. and Santer, Miriam (2023) Cost-effectiveness of Spironolactone for Adult Female Acne (SAFA): Economic evaluation alongside a randomised controlled trial. BMJ Open, 13 (12). ISSN 2044-6055
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Abstract
Objective This study aims to estimate the cost-effectiveness of oral spironolactone plus routine topical treatment compared with routine topical treatment alone for persistent acne in adult women from a British NHS perspective over 24 weeks. Design Economic evaluation undertaken alongside a pragmatic, parallel, double-blind, randomised trial. Setting Primary and secondary healthcare, community and social media advertising. Participants Women ≥18 years with persistent facial acne judged to warrant oral antibiotic treatment. Interventions Participants were randomised 1:1 to 50 mg/day spironolactone (increasing to 100 mg/day after 6 weeks) or matched placebo until week 24. Participants in both groups could continue topical treatment. Main outcome measures Cost-utility analysis assessed incremental cost per quality-adjusted life year (QALY) using the EQ-5D-5L. Cost-effectiveness analysis estimated incremental cost per unit change on the Acne-QoL symptom subscale. Adjusted analysis included randomisation stratification variables (centre, baseline severity (investigator's global assessment, IGA <3 vs ≥3)) and baseline variables (Acne-QoL symptom subscale score, resource use costs, EQ-5D score and use of topical treatments). Results Spironolactone did not appear cost-effective in the complete case analysis (n=126 spironolactone, n=109 control), compared with no active systemic treatment (adjusted incremental cost per QALY £67 191; unadjusted £34 770). Incremental cost per QALY was £27 879 (adjusted), just below the upper National Institute for Health and Care Excellence's threshold value of £30 000, where multiple imputation took account of missing data. Incremental cost per QALY for other sensitivity analyses varied around the base-case, highlighting the degree of uncertainty. The adjusted incremental cost per point change on the Acne-QoL symptom subscale for spironolactone compared with no active systemic treatment was £38.21 (complete case analysis). Conclusions The results demonstrate a high level of uncertainty, particularly with respect to estimates of incremental QALYs. Compared with no active systemic treatment, spironolactone was estimated to be marginally cost-effective where multiple imputation was performed but was not cost-effective in complete case analysis. Trial registration number ISRCTN registry (ISRCTN12892056).
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | acne,adult dermatology,clinical trial,dermatology,health economics,health economics,medicine(all),sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Health Economics Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 10 Dec 2024 01:46 |
| Last Modified: | 06 Feb 2025 12:28 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/97964 |
| DOI: | 10.1136/bmjopen-2023-073245 |
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