OBJECTIVES : Atopic dermatitis (AD) is an inflammatory, chronic skin disease defined by flare-ups periods. This disorder affects health and quality of life of patients. The follow-up of AD and the prevention of relapses have a great impact on health care, society costs but also on patient’s expenditures. The aim of the study is to assess the cost-effectiveness of different emollients prescribed in AD patients

METHODS : A Markov simulation model was developed over a 5-year period including data from different sources: (i) randomized clinical trials and literature review for the efficacy of treatments, (ii) resource utilisation and quality of life data, and (iii) unit prices from official prices lists. Three perspectives were considered: NHS/PSS, society which adds productivity losses and patient which includes out-of-pocket expenditures. 4 different emollients were compared (A, B, C, D) with no emollient users. Patients were treated with topical corticosteroid during flare-ups periods. Two outcomes were used to evaluate the cost-effectiveness: QALY and time without flare-ups. Sensitivity analysis were performed.

RESULTS : The 5-year costs associated with the different emollients amounts to ₤1,329 and generates 3.55 QALY for emollient A. Patients spend in average 3.89 years without flare-ups periods. Compared to emollient B, emollient A is costlier (Δ₤42) but more effective (0.08 years, corresponding to a 30-day difference without flare-ups between A and B, or 0.009 QALY). The ICER is ₤515 per year without flare-ups periods and ₤4,672 per QALY. Emollient A is the dominant strategy compared to no treatment (184 more days without flare-ups and ₤268.85 cheaper), emollient B or C.

CONCLUSIONS : According to the analysis, treatment with preventive emollient was a cost-effective option compared with no treatment in adult AD patients. In this comparative study, emollient A is the most efficient strategy from a willingness to pay of ₤500 with a probability of 47%.