Emollients cost-effective treatment for patients with Atopic Dermatitis: Study

Atopic dermatitis (AD) is an inflammatory skin condition affecting between 5 and 20% of children. This disease mostly recovers by itself at adulthood in 85% of cases. In industrialised countries, the prevalence of AD has tripled in the last 30 years. AD relapses are prevented by the daily use of a moisturiser. Thus, NICE recommends moisturisers as the first-line of treatment in delaying flare-ups, and corticoids to treat acute phases. Nevertheless, this therapy aims only to manage the symptoms. It improves the quality of life by decreasing the frequency and the intensity of flare-ups, the number of visits to a doctor, and the loss of productivity. While a collection of emollient (moisturiser) floods the market, their efficiency is not well known. Only few cost-effectiveness studies have been published and none were comparing an overall set of emollients. For this purpose, researchers of France conducted a study to assess the cost-effectiveness of different emollients prescribed to AD patients.

It was a cost-effective comparative study. Researchers adopted two perspectives, a health care system perspective and a social perspective. They developed a three-state Markov simulation model over a six-year period with 28 days cycles and compared two dermo-cosmetic emollients (A and D) with

• a mass-market emollient (emollient B)

• an emollient medical device (MD) (C) and

• no emollient.

The emollients were categorised based on INCI (International Nomenclature of Cosmetic Ingredients)

The major outcome assessed was the time without a flare-up. They also assessed quality-adjusted life-years (QALYs). They used data from

(i)Randomised clinical trials and literature review for the efficacy of treatments

(ii) Resource utilization and quality of life data and

(iii) Unit prices from official price lists.

Key findings of the study were:

♦ Researchers found the six-year health care costs associated with emollient A was £ 1844.23 and generated 4.58 years without a flare-up.

♦ On comparing with emollient B, they found emollient A was costlier (Δ £ 41) but more effective (0.097 years).

♦ They also found Emollient A is the dominant strategy compared to no treatment (£ 2,251.01; 3.99 years without flare-ups).

♦ They noted the incremental cost-effectiveness ratio (ICER) was £ 428.30 per year without a flare-up.

♦ They reported, "when accounting for the societal costs, emollient A is the dominant strategy".

The authors concluded, "According to the analysis, treatment with preventive emollient was a cost-effective option compared with no treatment in adult AD patients. In this comparative study, emollient A is the most efficient strategy from a willingness to pay £ 200 with a probability of 49%".