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Original Investigation
February 6, 2017

Cost-effectiveness of Prophylactic Moisturization for Atopic Dermatitis

Author Affiliations
  • 1Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Industrial Engineering and Management Sciences, Northwestern University, Chicago, Illinois
  • 3Chicago Integrative Eczema Center, Chicago, Illinois
JAMA Pediatr. 2017;171(2):e163909. doi:10.1001/jamapediatrics.2016.3909
Key Points

Question  What is the cost benefit of using moisturizers for the prevention of atopic dermatitis in high-risk newborns?

Findings  In this cost-effectiveness study, there was an incremental quality-adjusted life-year (QALY) benefit of prophylactic moisturization with 7 common moisturizers used in a 6-month window. Overall, the prophylactic use of moisturizers was determined to be cost-effective, with petroleum jelly demonstrating the best cost-benefit ratio ($353/QALY).

Meaning  Prophylactic moisturization for atopic dermatitis in high-risk newborns is likely to be cost-effective for all 7 moisturizers studied.

Abstract

Importance  Emerging evidence suggests that the use of moisturizers on newborns and infants (ie, from birth to 6 months of age) is potentially helpful in preventing the development of atopic dermatitis.

Objective  To investigate the cost-effectiveness of using a daily moisturizer as prevention against atopic dermatitis among high-risk newborns.

Design, Setting, and Participants  In a cost-effectiveness analysis, the average cost of total-body moisturization using 7 common moisturizers from birth to 6 months of age was determined for male and female infants. We assumed the same unit of weight per moisturizer used for a given body surface area. Based on previously reported data (relative risk reduction of 50%), the incremental gain in quality-adjusted life-years (QALYs) was determined using a 6-month time window. The cost-effectiveness of each moisturizer was determined by assuming equal efficacy. A sensitivity analysis was conducted by varying the relative risk from 0.28 to 0.90.

Interventions  Use of prophylactic moisturizing compounds.

Main Outcomes and Measures  The primary outcomes were the incremental cost-effectiveness values ($/QALY) for each moisturizer in preventing atopic dermatitis during a 6-month time window.

Results  The calculated amount of daily all-body moisturizer needed at birth was 3.6 g (0.12 oz) per application, which increased to 6.6 g (0.22 oz) at 6 months of age. Of the 7 products evaluated, the average price was $1.07/oz (range, $0.13/oz-$2.96/oz). For a 6-month time window, the average incremental QALY benefit was 0.021. The sensitivity analysis showed that the incremental gain of QALY ranged from 0.0041 to 0.030. Petrolatum was the most cost-effective ($353/QALY [95% CI, $244-$1769/QALY) moisturizer in the cohort. Even assuming the lowest incremental QALYs for the most expensive moisturizer, the intervention was still less than $45 000/QALY.

Conclusions and Relevance  Overall, atopic dermatitis represents a major health expenditure and has been associated with multiple comorbidities. Daily moisturization may represent a cost-effective, preventative strategy to reduce the burden of atopic dermatitis.

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