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 .

• Journal Article Type: Article
• Acceptance Date: Nov 14, 2023
• Online Publication Date: Jan 9, 2024
• Publication Date: Jan 9, 2024
• 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
• 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