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An economic evaluation of the randomised controlled trial of topical corticosteroid and home‐based narrowband UVB for active and limited vitiligo (The HI‐Light Trial)

An economic evaluation of the randomised controlled trial of topical corticosteroid and home‐based narrowband UVB for active and limited vitiligo (The HI‐Light Trial)
An economic evaluation of the randomised controlled trial of topical corticosteroid and home‐based narrowband UVB for active and limited vitiligo (The HI‐Light Trial)
Background

Economic evidence for vitiligo treatments is absent.

Objective

To determine the cost‐effectiveness of (a) hand‐held narrowband‐UVB (NB‐UVB) and (b) combination of topical corticosteroid (TCS) and NB‐UVB compared to TCS for localised vitiligo.

Methods

Cost‐effectiveness analysis alongside a pragmatic, 3‐arm, placebo‐controlled RCT with 9 months’ treatment. 517 Adults and children (aged ≥5 years) with active vitiligo affecting <10% of skin recruited from secondary care and community were randomised 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 QALYs using the EQ‐5D‐5L for those aged 11+ and CHU‐9D for those aged 5 to <18.

Results

Mean (SD) cost per participant was £774.4 (83.71) for NB‐UVB, £813.38 (111.39) for combination treatment and £599.98 (96.18) for TCS. In analyses adjusted for age and target patch location, incremental difference in cost for combination treatment compared to TCS was £211.46 (95% CI 188.10 to 234.81), corresponding to a risk difference of 10.94% (Number‐Needed‐To‐Treat (NNT= 9). Incremental cost was £1,932.35 per successful treatment. The incremental difference in cost for NB‐UVB compared to TCS was £173.44 (95% CI 150.55 to 196.32) with a risk difference of 5.20% (NNT=19). Incremental cost was £3,335.74 per successful treatment.

Conclusion

Combination treatment, compared to 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 £1,932 per additional treatment success.

0007-0963
Sach, Tracey
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Thomas, Kim
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Batchelor, Jonathan
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Akram, Perways
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Chalmers, Joanne
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Haines, Rachel
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Meakin, Garry
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Duley, Lelia
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Ravenscroft, Jane
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Rogers, Andy
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Santer, Miriam
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Tan, Wei
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Sach, Tracey, Thomas, Kim, Batchelor, Jonathan, Akram, Perways, Chalmers, Joanne, Haines, Rachel, Meakin, Garry, Duley, Lelia, Ravenscroft, Jane, Rogers, Andy, Santer, Miriam, Tan, Wei, Whitton, Maxine, Williams, Hywel, Cheung, S., Hamad, Hannah, Wright, A., Ingram, John R., Levell, Nick, Goulding, J.M.R., Makrygeorgou, A., Bewley, A., Ogboli, M., Stainforth, J., Ferguson, A., Laguda, B., Wahie, Shyamal, Ellis, R., Azad, J., Rajasekaran, A., Eleftheriadou, Viktoria and Montgomery, A.A. (2020) An economic evaluation of the randomised controlled trial of topical corticosteroid and home‐based narrowband UVB for active and limited vitiligo (The HI‐Light Trial). British Journal of Dermatology. (doi:10.1111/bjd.19554).

Record type: Article

Abstract

Background

Economic evidence for vitiligo treatments is absent.

Objective

To determine the cost‐effectiveness of (a) hand‐held narrowband‐UVB (NB‐UVB) and (b) combination of topical corticosteroid (TCS) and NB‐UVB compared to TCS for localised vitiligo.

Methods

Cost‐effectiveness analysis alongside a pragmatic, 3‐arm, placebo‐controlled RCT with 9 months’ treatment. 517 Adults and children (aged ≥5 years) with active vitiligo affecting <10% of skin recruited from secondary care and community were randomised 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 QALYs using the EQ‐5D‐5L for those aged 11+ and CHU‐9D for those aged 5 to <18.

Results

Mean (SD) cost per participant was £774.4 (83.71) for NB‐UVB, £813.38 (111.39) for combination treatment and £599.98 (96.18) for TCS. In analyses adjusted for age and target patch location, incremental difference in cost for combination treatment compared to TCS was £211.46 (95% CI 188.10 to 234.81), corresponding to a risk difference of 10.94% (Number‐Needed‐To‐Treat (NNT= 9). Incremental cost was £1,932.35 per successful treatment. The incremental difference in cost for NB‐UVB compared to TCS was £173.44 (95% CI 150.55 to 196.32) with a risk difference of 5.20% (NNT=19). Incremental cost was £3,335.74 per successful treatment.

Conclusion

Combination treatment, compared to 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 £1,932 per additional treatment success.

Text
bjd.19554 - Accepted Manuscript
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More information

e-pub ahead of print date: 12 September 2020

Identifiers

Local EPrints ID: 444660
URI: http://eprints.soton.ac.uk/id/eprint/444660
ISSN: 0007-0963
PURE UUID: 75d55bee-b9ca-4b2d-8f25-b9d7e8f1b7cc
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260

Catalogue record

Date deposited: 28 Oct 2020 18:04
Last modified: 09 Jan 2022 08:14

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Contributors

Author: Tracey Sach
Author: Kim Thomas
Author: Jonathan Batchelor
Author: Perways Akram
Author: Joanne Chalmers
Author: Rachel Haines
Author: Garry Meakin
Author: Lelia Duley
Author: Jane Ravenscroft
Author: Andy Rogers
Author: Miriam Santer ORCID iD
Author: Wei Tan
Author: Maxine Whitton
Author: Hywel Williams
Author: S. Cheung
Author: Hannah Hamad
Author: A. Wright
Author: John R. Ingram
Author: Nick 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: Shyamal Wahie
Author: R. Ellis
Author: J. Azad
Author: A. Rajasekaran
Author: Viktoria Eleftheriadou
Author: A.A. Montgomery

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