Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Clin Exp Allergy. 2023 Oct;53(10):1011-1019. doi: 10.1111/cea.14381. Epub 2023 Aug 13.
Recent discoveries have led to the suggestion that enhancing skin barrier from birth might prevent eczema and food allergy.
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.
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.
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.
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.
最近的发现表明，从出生起就增强皮肤屏障功能可能预防特应性皮炎和食物过敏。
从卫生服务的角度出发，确定在高危儿童生命的第一年中每天全身涂抹保湿剂以预防特应性湿疹的成本效益，我们也考虑了 5 年的时间范围作为敏感性分析。
在 BEEP 试验中，使用健康资源使用和生活质量数据进行了一项试验内经济评估，这些数据是作为试验数据的一部分捕获的。1394 名高风险特应性疾病家庭出生的婴儿的父母/照顾者被随机分配到 1:1 的保湿剂组，该组被建议在生命的第一年中每天至少一次将保湿剂（Doublebase 凝胶或 Diprobase 霜）涂抹到孩子全身，或接受常规护理。两组均接受了一般皮肤护理建议。主要的经济结果是增量成本效益比（ICER），定义为初级成本效益分析中湿疹风险降低的百分比的增量成本。作为成本效益分析进行的二次分析报告了增量成本每质量调整生命年（QALY），其中儿童效用是在 2 岁时使用代理 CHU-9D 得出的。
在 2 岁时，每位参与者的调整后增量成本为 87.45 英镑（95%CI-54.31，229.27），而无湿疹的比例为 0.0164（95%CI-0.0329，0.0656）。湿疹风险降低的百分比的 ICER 为 5337 英镑。保湿剂组的调整后增量 QALY 略有改善，为 0.0010（95%CI-0.0069，0.0089）。在 5 岁时，保湿剂组的调整后增量成本更低，为-106.89 英镑（95%CI-354.66，140.88），且无湿疹的比例为-0.0329（95%CI-0.0659，0.0002）。5 年的 ICER 为湿疹风险降低的百分比的 3201 英镑。然而，当排除因喘息而导致的住院费用时，常规护理组的增量成本更低，增量效果更大。
与有效性终点一致，BEEP 试验中建议在婴儿期每天使用保湿剂预防高危儿童湿疹的做法似乎并不具有成本效益。
