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An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial)

An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial)
An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial)
Background: Economic evidence for vitiligo treatments is absent.
Objectives: To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo.
Methods: Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months’ treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost–utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015.
Results: The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188–235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151–196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment.
Conclusions: Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.
Adrenal Cortex Hormones, Adult, Child, Combined Modality Therapy, Cost-Benefit Analysis, Humans, Treatment Outcome, Ultraviolet Therapy, Vitiligo/drug therapy
0007-0963
840-848
Sach, T H
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Thomas, K S
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Batchelor, J M
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Perways, A
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Chalmers, J R
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Haines, R H
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Meakin, G D
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Duley, L
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Ravenscroft, J C
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Rogers, A
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Santer, M
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Tan, W
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White, J
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Whitton, M E
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Williams, H C
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Cheung, S T
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Hamad, H
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Wright, A
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Ingram, J R
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Levell, N
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Goulding, J M R
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Makrygeorgou, A
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Bewley, A
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Ogboli, M
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Stainforth, J
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Ferguson, A
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Laguda, B
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Wahie, S
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Ellis, R
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Azad, J
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Rajasekaran, A
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Eleftheriadou, V
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Montgomery, A A
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UK Dermatology Clinical Trials Network’s HI-LIGHT Vitiligo Trial Team
Sach, T H
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Thomas, K S
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Batchelor, J M
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Perways, A
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Chalmers, J R
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Haines, R H
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Meakin, G D
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Duley, L
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Ravenscroft, J C
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Rogers, A
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Santer, M
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Tan, W
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White, J
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Whitton, M E
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Williams, H C
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Cheung, S T
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Hamad, H
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Wright, A
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Ingram, J R
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Levell, N
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Goulding, J M R
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Makrygeorgou, A
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Bewley, A
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Ogboli, M
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Stainforth, J
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Ferguson, A
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Laguda, B
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Wahie, S
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Ellis, R
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Azad, J
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Rajasekaran, A
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Eleftheriadou, V
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Montgomery, A A
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Sach, T H, Thomas, K S, Batchelor, J M, Perways, A, Rogers, A, Santer, M, Tan, W, Whitton, M E, Williams, H C, Wright, A, Ingram, J R and Ferguson, A , UK Dermatology Clinical Trials Network’s HI-LIGHT Vitiligo Trial Team (2021) An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial). British Journal of Dermatology, 184 (5), 840-848. (doi:10.1111/bjd.19554).

Record type: Article

Abstract

Background: Economic evidence for vitiligo treatments is absent.
Objectives: To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo.
Methods: Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months’ treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost–utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015.
Results: The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188–235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151–196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment.
Conclusions: Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.

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bjd.19554 - Accepted Manuscript
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e-pub ahead of print date: 12 September 2020
Published date: 1 May 2021
Additional Information: Funding Information: The authors would like to thank all those who supported and contributed to delivery of the HI‐Light trial, including the NIHR Clinical Research Network, for assistance in identifying recruitment sites, and provision of research infrastructure and staff, and the UK Dermatology Clinical Trials Network (DCTN) for help in trial design and identifying recruiting sites. The UK DCTN is grateful to the British Association of Dermatologists and the University of Nottingham for financial support of the Network. We are grateful to Dermfix Ltd ( www.dermfix.uk ) for providing the NB‐UVB devices and dummy devices at a reduced cost. Dermfix Ltd had no role in the design, conduct or analysis of the trial. Members of the Centre of Evidence Based Dermatology’s Patient Panel provided input into the trial design and conduct, and dissemination of trial findings. Thanks also to the people who responded to online surveys to inform the trial design. We thank Emma McManus for review and comments on the Health Economics Analysis Plan. A full list of contributors is provided in Appendix S2 (see Supporting Information). Publisher Copyright: © 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists
Keywords: Adrenal Cortex Hormones, Adult, Child, Combined Modality Therapy, Cost-Benefit Analysis, Humans, Treatment Outcome, Ultraviolet Therapy, Vitiligo/drug therapy

Identifiers

Local EPrints ID: 444660
URI: http://eprints.soton.ac.uk/id/eprint/444660
DOI: doi:10.1111/bjd.19554
ISSN: 0007-0963
PURE UUID: 75d55bee-b9ca-4b2d-8f25-b9d7e8f1b7cc
ORCID for T H Sach: ORCID iD orcid.org/0000-0002-8098-9220
ORCID for J M Batchelor: ORCID iD orcid.org/0000-0002-5307-552X
ORCID for M Santer: ORCID iD orcid.org/0000-0001-7264-5260

Catalogue record

Date deposited: 28 Oct 2020 18:04
Last modified: 17 Mar 2024 06:00

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Contributors

Author: T H Sach ORCID iD
Author: K S Thomas
Author: J M Batchelor ORCID iD
Author: A Perways
Author: J R Chalmers
Author: R H Haines
Author: G D Meakin
Author: L Duley
Author: J C Ravenscroft
Author: A Rogers
Author: M Santer ORCID iD
Author: W Tan
Author: J White
Author: M E Whitton
Author: H C Williams
Author: S T Cheung
Author: H Hamad
Author: A Wright
Author: J R Ingram
Author: N Levell
Author: J M R Goulding
Author: A Makrygeorgou
Author: A Bewley
Author: M Ogboli
Author: J Stainforth
Author: A Ferguson
Author: B Laguda
Author: S Wahie
Author: R Ellis
Author: J Azad
Author: A Rajasekaran
Author: V Eleftheriadou
Author: A A Montgomery
Corporate Author: UK Dermatology Clinical Trials Network’s HI-LIGHT Vitiligo Trial Team

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