Pitt M, Garside R, Stein K
Peninsula Technology Assessment Group, Peninsula Medical School, Dean Clarke House, Southernhay East, Exeter EX1 1PQ, U.K.
Br J Dermatol. 2006 Jun;154(6):1137-46. doi: 10.1111/j.1365-2133.2006.07184.x.
Conventional treatments for atopic eczema include topical corticosteroids (TCS) and emollients. Pimecrolimus, an immunosuppressant, was licensed in the U.K. in 2003 as an alternative treatment of mild to moderate atopic eczema.
To assess the cost-utility of pimecrolimus as a treatment for mild and moderate atopic eczema when compared with conventional treatments which use TCS and emollients.
A Markov state-transition model was developed to represent the cyclical nature of atopic eczema and provide an economic analysis of cost-utility for treatment alternatives from the perspective of a third party payer (U.K. National Health Service). A range of methods was used to obtain data for transition probabilities, costs and quality of life. These included a systematic review of published effectiveness data, expert opinion, and a utility study conducted by the authors. Separate cohort analyses were modelled to distinguish between children and adult populations and between differing treatment patterns for facial and body eczema. One-way sensitivity analyses and probabilistic sensitivity analysis (using Monte-Carlo simulation) were performed.
Baseline cost-utility outputs from the model show that, in all tested scenarios, TCS dominate pimecrolimus (i.e. TCS are both cheaper and more effective). However, the differences in benefits between treatments output by the model are very small. Sensitivity analyses highlight the importance of cost variations in pimecrolimus. Where pimecrolimus is compared with emollient only it is probably cost effective at a willingness-to-pay threshold of 30 000 UK pounds per quality-adjusted life year.
There are likely to be few situations in which the use of pimecrolimus for the treatment of atopic eczema can be justified on economic grounds. Exceptions are likely to be in cases where TCS have been shown to be ineffective, unacceptable due to adverse events, or where a patient is unwilling to accept TCS treatment despite appropriate education and support and emollient alone is the alternative clinical option.
特应性皮炎的传统治疗方法包括外用糖皮质激素（TCS）和润肤剂。吡美莫司作为一种免疫抑制剂，于2003年在英国获批，作为轻度至中度特应性皮炎的替代治疗方法。
评估与使用TCS和润肤剂的传统治疗方法相比，吡美莫司治疗轻度和中度特应性皮炎的成本效益。
建立了一个马尔可夫状态转换模型，以体现特应性皮炎的周期性，并从第三方支付者（英国国家医疗服务体系）的角度对治疗方案的成本效益进行经济分析。采用一系列方法获取转移概率、成本和生活质量的数据。这些方法包括对已发表的有效性数据进行系统评价、专家意见以及作者进行的效用研究。进行了单独的队列分析，以区分儿童和成人人群以及面部和身体湿疹的不同治疗模式。进行了单向敏感性分析和概率敏感性分析（使用蒙特卡罗模拟）。
模型的基线成本效益输出表明，在所有测试方案中，TCS均优于吡美莫司（即TCS更便宜且更有效）。然而，模型输出的治疗方法之间的效益差异非常小。敏感性分析突出了吡美莫司成本变化的重要性。当仅将吡美莫司与润肤剂进行比较时，在每质量调整生命年30000英镑的支付意愿阈值下，它可能具有成本效益。
从经济角度来看，可以证明使用吡美莫司治疗特应性皮炎的情况可能很少。例外情况可能是TCS已被证明无效、因不良事件不可接受，或者患者尽管经过适当的教育和支持仍不愿接受TCS治疗，而仅使用润肤剂是替代临床选择的情况。
