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

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

Abstract

Objective: To estimate the cost-effectiveness of online behavioral interventions (EczemaCareOnline.org.uk) designed to support 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-specified 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 0–12years and Trial 2 337 young people aged 13–25years 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 www.EczemaCareOnline.org.uk .

Citation

Sach, T. H., Onoja, M., Clarke, H., Santer, M., Muller, I., Becque, T., Stuart, B., Hooper, J., Steele, M., Wilczynska, S., Ridd, M. J., Roberts, A., Ahmed, A., Yardley, L., Little, P., Greenwell, K., Sivyer, K., Nuttall, J., Griffiths, G., Lawton, S., …Thomas, K. S. (2024). Cost-effectiveness of two online interventions supporting self-care for eczema for parents/carers and young people. European Journal of Health Economics, 25(7), 1165–1176. https://doi.org/10.1007/s10198-023-01649-9

• Journal Article Type: Article
• Acceptance Date: Nov 14, 2023
• Online Publication Date: Jan 9, 2024
• Publication Date: 2024-09
• Deposit Date: Jan 25, 2024
• Publicly Available Date: Jan 30, 2024
• Journal: European Journal of Health Economics
• Print ISSN: 1618-7598
• Electronic ISSN: 1618-7601
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 7
• Pages: 1165–1176
• DOI: https://doi.org/10.1007/s10198-023-01649-9
• Keywords: Economic evaluation · Cost-effectiveness; Atopic eczema; Atopic dermatitis; Online interventionss
• Public URL: https://nottingham-repository.worktribe.com/output/29556857
• Publisher URL: https://link.springer.com/article/10.1007/s10198-023-01649-9