Sach, Tracey H., Onoja, Mary, Clarke, Holly, Santer, Miriam, Muller, Ingrid, Becque, Taeko, Stuart, Beth, Hooper, Julie, Steele, Mary, Wilczynska, Sylvia, Ridd, Matthew J., Roberts, Amanda, Ahmed, Amina, Yardley, Lucy, Little, Paul, Greenwell, Kate, Sivyer, Katy, Nuttall, Jacqui, Griffiths, Gareth, Lawton, Sandra, Langan, Sinéad M., Howells, Laura, Leighton, Paul, Williams, Hywel C. and Thomas, Kim S. (2024) Cost effectiveness of two online interventions supporting self-care for eczema for parents/carers and young people. The European Journal of Health Economics, 25 (7), 1165-1176. (doi:10.1007/s10198-023-01649-9).
Abstract
Objective: to estimate the cost-effectiveness of online behavioural 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 randomised 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 randomised (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% to 18.1%).
Conclusion: the free at point of use online eczema self-management intervention was low cost to run and cost-effective.
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