Exploring the relative costs and benefits of commonly prescribed emollients for the treatment of childhood eczema in primary care

PhD project (3/4 yr research project leading to independent research at the doctorate level)

Matthew Ridd, Sian Noble


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Rationale

Atopic eczema/dermatitis is a common long term condition in children. It is characterised by dry and itchy skin, and it can have a significant impact on the quality of a child’s life and their family. The majority of children with eczema are treated by GPs with emollients and topical corticosteroids. However, there are many different emollients with little evidence that any one is better than another.

In England alone, just under 14.5 million prescriptions for emollients were issued on the NHS in 2014, at a total cost of more than £96m. Therefore, even small changes in prescribing in favour of the most cost-effective emollients could result in considerable cost savings year-on-year.

We have demonstrated in a previous study (COMET) that it is possible to collect and cost the information required to perform an economic evaluation of an RCT comparing the effectiveness of four different types of emollient for the treatment of children with eczema.

Aims & objectives

Aim: to explore relative costs & benefits of 4 emollients for the treatment of childhood eczema.
Objectives:
• Estimate NHS and parental costs of caring for children with eczema using one of 4 different emollients
• Explore feasibility of estimating Quality Adjusted Life Years for children with eczema
• Estimate cost-effectiveness of 4 different emollients
• Estimate budgetary impact of prescribing the most similar, cheapest emollient in each class of lotion, cream, gel and ointment

Methods

This project will be closely linked to an RCT of 520 children (6 months to 12 years old) with eczema who will be randomised to a lotion, cream, gel or ointment. An economic evaluation will be undertaken from the perspectives of the NHS and parents/carers, at 16 and 52 weeks, to capture short and long term cost-effectiveness.

The COMET study found that parents purchased many additional or substitute items due to their child’s eczema, incurring additional costs. One task will be to develop these findings and devise an efficient method of data collection for the main trial.

The BEE trial will measure quality of life using: the ADQoL and CHU9D for the participant children; the EQ-5D-5L for the main carer; and DFI for the family. An important component of the project will be to explore how these measures can be used to estimate QALYs.

The cost and outcome data will be combined to present estimates of cost-effectiveness. This is likely to involve both a cost-consequences approach

References

Ridd et al. Choice of Moisturiser for Eczema Treatment (COMET): study protocol for a randomized controlled trial." Trials 2015; 16(1): 304. Doi: 10.1186/s13063-015-0830-y

Ridd et al. Choice of Moisturiser for Eczema Treatment (COMET): feasibility study of a randomised controlled parallel group tr


Created on Dec. 6, 2016, 10:33 a.m.

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