Cost-effectiveness of two online interventions supporting self-care for eczema for parents/carers and young people

Tracey H Sach; Mary Onoja; Holly Clarke; Miriam Santer; Ingrid Muller; Taeko Becque; Beth Stuart; Julie Hooper; Mary Steele; Sylvia Wilczynska; Matthew J Ridd; Amanda Roberts; Amina Ahmed; Lucy Yardley; Paul Little; Kate Greenwell; Katy Sivyer; Jacqui Nuttall; Gareth Griffiths; Sandra Lawton; Sinéad M Langan; Laura Howells; Paul Leighton; Hywel C Williams; Kim S Thomas

doi:10.1007/s10198-023-01649-9

Cost-effectiveness of two online interventions supporting self-care for eczema for parents/carers and young people

Eur J Health Econ. 2024 Jan 9. doi: 10.1007/s10198-023-01649-9. Online ahead of print.

Authors

Tracey H Sach^{1

2}, Mary Onoja³, Holly Clarke³, Miriam Santer⁴, Ingrid Muller⁴, Taeko Becque⁴, Beth Stuart^{4

5}, Julie Hooper⁴, Mary Steele⁴, Sylvia Wilczynska⁶, Matthew J Ridd⁷, Amanda Roberts⁸, Amina Ahmed⁸, Lucy Yardley⁹, Paul Little⁴, Kate Greenwell^{4

9

10}, Katy Sivyer^{9

10}, Jacqui Nuttall¹¹, Gareth Griffiths¹¹, Sandra Lawton¹², Sinéad M Langan¹³, Laura Howells¹⁴, Paul Leighton¹⁴, Hywel C Williams¹⁴, Kim S Thomas¹⁴

Affiliations

¹ Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK. T.sach@Soton.ac.uk.
² Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK. T.sach@Soton.ac.uk.
³ Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
⁴ Primary Care Research Centre, Faculty of Medicine, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK.
⁵ Pragmatic Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
⁶ King's Clinical Trial Unit, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK.
⁷ Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
⁸ Patient and Public Contributor, Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building (Building Number 42), University Park, Nottingham, NG7 2RD, UK.
⁹ Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
¹⁰ School of Psychological Science, University of Bristol, 12A Priory Rd, Bristol, BS8 1TU, UK.
¹¹ Southampton Clinical Trial Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹² Dermatology, The Rotherham NHS Foundation Trust, Rotherham, UK.
¹³ Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
¹⁴ Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building (Building Number 42), University Park, Nottingham, NG7 2RD, UK.

PMID: 38194207
DOI: 10.1007/s10198-023-01649-9

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 0-12 years and Trial 2 337 young people aged 13-25 years 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 .

Keywords: Atopic dermatitis; Atopic eczema; Cost-effectiveness; Economic evaluation; Online interventions.

Associated data

ISRCTN/ISRCTN79282252

Grants and funding

RP-PG-0216-20007/Programme Grants for Applied Research