title: Costs and cost-effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs.
abstract: BACKGROUND
  In a randomized, controlled trial (RCT) on childhood eczema we reported that substituting nurse practitioners (NPs) for dermatologists resulted in similar outcomes of eczema severity and in the quality of life, and higher patient satisfaction.
  
  
  OBJECTIVE
  To determine costs and cost-effectiveness of care provided by NPs vs. dermatologists and to compare our results with those in studies from other countries.
  
  
  METHODS
  We estimated the healthcare costs, family costs and the costs in other sectors alongside the RCT. All the costs were linked to quality of life [Infants' Dermatitis Quality of Life Index (IDQOL), Children's Dermatology Life Quality Index (CDLQI)] and to patient satisfaction (Client Satisfaction Questionnaire-8) to determine the incremental cost-effectiveness ratio (ICER). We also examined all the reported studies on the costs of childhood eczema.
  
  
  RESULTS
  The mean annual healthcare costs, family costs and costs in other sectors were €658, €302 and €21, respectively, in the NP group and €801, €608 and €0·93, respectively, in the dermatologist group. The ICER in the NP group compared with the dermatologist group indicated €925 and €751 savings per one point less improvement in IDQOL and CDLQI, respectively, and €251 savings per one point more satisfaction in the NP group at 12 months. The mean annual healthcare costs and family costs varied considerably in the six identified studies.
  
  
  CONCLUSIONS
  Substituting NPs for dermatologists is both cost-saving and cost-effective. The treatment of choice is that provided by the NPs as it is similarly effective to treatment provided by a dermatologist with a higher parent satisfaction. International comparisons are difficult because the types of costs determined, the units and unit prices, and eczema severity all differ between studies.
authors.affiliation: Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.l.a.schuttelaar@umcg.nl
authors.forename: M L A
authors.initials: ML
authors.lastname: Schuttelaar
authors.forename: K M
authors.initials: KM
authors.lastname: Vermeulen
authors.forename: P J
authors.initials: PJ
authors.lastname: Coenraads
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003876:Dermatitis, Atopic / Q000191:economics* / Q000628:therapy; D003880:Dermatology / Q000191:economics*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D009426:Netherlands; D009722:Nurse Practitioners / Q000191:economics*; D017060:Patient Satisfaction; D011788:Quality of Life; D013689:Telephone / Q000191:economics