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


About This PhD Project

Project Description

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. Most children with eczema are treated by GPs with moisturisers (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. BEE (Best Emollient for Eczema) is a NIHR HTA-funded trial that by comparing the effectiveness and acceptability of different emollients will answer the research question “Which is the best emollient to prescribe for treating the symptoms of childhood eczema – lotion, cream, gel or ointment?”

Aim
To explore relative costs & benefits of emollients for the treatment of childhood eczema. Objectives: · Estimate NHS and parental costs of caring for children with eczema using one of four different types of emollient · Explore feasibility of estimating Quality Adjusted Life Years for children with eczema · Estimate cost-effectiveness of four different types of emollients · Estimate budgetary impact of prescribing the most similar, cheapest emollient in each type of emollient

Methods
520 children (6 months-12 years old) with eczema will be randomised to a lotion, cream, gel or ointment. The economic evaluation will be from the perspectives of the NHS and parents/carers, at 16 and 52 weeks, to capture short and long-term cost-effectiveness. We know that many parents purchase or substitute items due to their child’s eczema, with additional costs. One task will be to develop these findings and devise an efficient method of data collection for the main trial.

Quality of life will be measured using the ADQoL and CHU9D for the participant children; 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 and a cost-effectiveness analysis. The budgetary impact of prescribing the most similar cheapest emollient in each type of emollient will be explored.

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 trial in children recruited from primary care. BMJ Open 2016 DOI:10.1136/bmjopen-2016-012021

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