T H Sach1, K S Thomas2, J M Batchelor2, A Perways3, J R Chalmers2, R H Haines4, G D Meakin4, L Duley4, J C Ravenscroft5, A Rogers3, M Santer6, W Tan4, J White4, M E Whitton2, H C Williams2, S T Cheung7, H Hamad7, A Wright8, J R Ingram9, N Levell10, J M R Goulding11, A Makrygeorgou12, A Bewley13, M Ogboli14, J Stainforth15, A Ferguson16, B Laguda17, S Wahie18, R Ellis19, J Azad19, A Rajasekaran20, V Eleftheriadou21, A A Montgomery4. 1. Norwich Medical School, University of East Anglia, Norwich, UK. 2. Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK. 3. Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK. 4. Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK. 5. Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK. 6. Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, UK. 7. Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK. 8. St Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK. 9. Division of Infection and Immunity, Cardiff University, Cardiff, UK. 10. Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. 11. Solihull Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK. 12. West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK. 13. Whipps Cross Hospital and The Royal London Hospital, Barts Health NHS Trust, London, UK. 14. Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK. 15. York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK. 16. Royal Derby Hospital and the London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK. 17. Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK. 18. University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK. 19. The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK. 20. Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. 21. Leicester Royal Infirmary, Leicester, UK.
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.
RCT Entities:
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.
Authors: Jonathan M Batchelor; Kim S Thomas; Perways Akram; Jaskiran Azad; Anthony Bewley; Joanne R Chalmers; Seau Tak Cheung; Lelia Duley; Viktoria Eleftheriadou; Robert Ellis; Adam Ferguson; Jonathan Mr Goulding; Rachel H Haines; Hamdi Hamad; John R Ingram; Bisola Laguda; Paul Leighton; Nick Levell; Areti Makrygeorgou; Garry D Meakin; Adam Millington; Malobi Ogboli; Amirtha Rajasekaran; Jane C Ravenscroft; Andrew Rogers; Tracey H Sach; Miriam Santer; Julia Stainforth; Wei Tan; Shyamal Wahie; Jennifer White; Maxine E Whitton; Hywel C Williams; Andrew Wright; Alan A Montgomery Journal: Health Technol Assess Date: 2020-11 Impact factor: 4.014
Authors: Paul Leighton; Joanne R Chalmers; Jonathan M Batchelor; Andy Rogers; Perways Akram; Rachel H Haines; Garry D Meakin; Jennifer White; Jane C Ravenscroft; Tracey H Sach; Miriam Santer; Maxine E Whitton; Viktoria Eleftheriadou; Kim S Thomas Journal: Clin Exp Dermatol Date: 2022-05-30 Impact factor: 4.481