A cost-utility analysis of pimecrolimus vs. topical corticosteroids and emollients for the treatment of mild and moderate atopic eczema.
BACKGROUND
Conventional treatments for atopic eczema include topical corticosteroids (TCS) and emollients. Pimecrolimus, an immunosuppressant, was licensed in the U.K. in 2003 as an alternative treatment of mild to moderate atopic eczema.


OBJECTIVE
To assess the cost-utility of pimecrolimus as a treatment for mild and moderate atopic eczema when compared with conventional treatments which use TCS and emollients.


METHODS
A Markov state-transition model was developed to represent the cyclical nature of atopic eczema and provide an economic analysis of cost-utility for treatment alternatives from the perspective of a third party payer (U.K. National Health Service). A range of methods was used to obtain data for transition probabilities, costs and quality of life. These included a systematic review of published effectiveness data, expert opinion, and a utility study conducted by the authors. Separate cohort analyses were modelled to distinguish between children and adult populations and between differing treatment patterns for facial and body eczema. One-way sensitivity analyses and probabilistic sensitivity analysis (using Monte-Carlo simulation) were performed.


RESULTS
Baseline cost-utility outputs from the model show that, in all tested scenarios, TCS dominate pimecrolimus (i.e. TCS are both cheaper and more effective). However, the differences in benefits between treatments output by the model are very small. Sensitivity analyses highlight the importance of cost variations in pimecrolimus. Where pimecrolimus is compared with emollient only it is probably cost effective at a willingness-to-pay threshold of 30 000 UK pounds per quality-adjusted life year.


CONCLUSIONS
There are likely to be few situations in which the use of pimecrolimus for the treatment of atopic eczema can be justified on economic grounds. Exceptions are likely to be in cases where TCS have been shown to be ineffective, unacceptable due to adverse events, or where a patient is unwilling to accept TCS treatment despite appropriate education and support and emollient alone is the alternative clinical option.
Pitt
M
M
Peninsula Technology Assessment Group, Peninsula Medical School, Dean Clarke House, Southernhay East, Exeter EX1 1PQ, U.K. m.pitt@exeter.ac.uk
Garside
R
R
Stein
K
K
D000328:Adult; D002648:Child; D003365:Costs and Cost Analysis; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs; D004359:Drug Therapy, Combination; D004643:Emollients / Q000191:economics* / Q000627:therapeutic use; D004739:England; D005938:Glucocorticoids / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D011788:Quality of Life; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
D004643:Emollients; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; C117268:pimecrolimus; D016559:Tacrolimus