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

Sach, Tracey H.; Lartey, Stella T.; 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.; Williams, Hywel C.

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.

Citation

Sach, T. H., Lartey, S. T., Davies, C., Chalmers, J. R., Haines, R. H., Bradshaw, L. E., Montgomery, A. A., Thomas, K. S., Brown, S. J., Ridd, M. J., Lawton, S., Cork, M. J., Flohr, C., Mitchell, E., Swinden, R., Wyatt, L., Tarr, S., Davies‐Jones, S., Jay, N., Kelleher, M. M., …the BEEP Study Team. (2023). Emollients for preventing atopic eczema: Cost‐effectiveness analysis of the BEEP trial. Clinical and Experimental Allergy, 53(10), 1011-1019. https://doi.org/10.1111/cea.14381

• Journal Article Type: Article
• Acceptance Date: Jun 28, 2023
• Online Publication Date: Aug 13, 2023
• Publication Date: 2023-10
• Deposit Date: Dec 12, 2023
• Publicly Available Date: Dec 13, 2023
• Journal: Clinical & Experimental Allergy
• Print ISSN: 0954-7894
• Electronic ISSN: 1365-2222
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 53
• Issue: 10
• Pages: 1011-1019
• DOI: https://doi.org/10.1111/cea.14381
• Keywords: prevention, economic evaluation, emollients, cost‐effectiveness, atopic eczema
• Public URL: https://nottingham-repository.worktribe.com/output/24414534
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/cea.14381
• Additional Information: Received: 2023-03-03; Accepted: 2023-06-28; Published: 2023-08-13