Cost-effectiveness of Prophylactic Moisturization for Atopic Dermatitis | Allergy and Clinical Immunology | JAMA Pediatrics | JAMA Network
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1.
Shaw  TE, Currie  GP, Koudelka  CW, Simpson  EL.  Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health.  J Invest Dermatol. 2011;131(1):67-73.PubMedGoogle ScholarCrossref
2.
Nankervis  H, Thomas  KS, Delamere  FM, Barbarot  S, Rogers  NK, Williams  HC.  Scoping systematic review of treatments for eczema.  Programm Grants Appl Res. 2016;4(7). doi:10.3310/pgfar04070Google Scholar
3.
Zheng  T, Yu  J, Oh  MH, Zhu  Z.  The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma.  Allergy Asthma Immunol Res. 2011;3(2):67-73.PubMedGoogle ScholarCrossref
4.
Marenholz  I, Nickel  R, Rüschendorf  F,  et al.  Filaggrin loss-of-function mutations predispose to phenotypes involved in the atopic march.  J Allergy Clin Immunol. 2006;118(4):866-871.PubMedGoogle ScholarCrossref
5.
Izadi  N, Luu  M, Ong  PY, Tam  JS.  The role of skin barrier in the pathogenesis of food allergy.  Children (Basel). 2015;2(3):382-402.PubMedGoogle Scholar
6.
Weidinger  S, O’Sullivan  M, Illig  T,  et al.  Filaggrin mutations, atopic eczema, hay fever, and asthma in children.  J Allergy Clin Immunol. 2008;121(5):1203-1209. PubMedGoogle ScholarCrossref
7.
Esaki  H, Brunner  PM, Renert-Yuval  Y,  et al.  Early-onset pediatric atopic dermatitis is TH2 but also TH17 polarized in skin  [published online September 15, 2016].  J Allergy Clin Immunol. doi:10.1016/j.jaci.2016.07.013PubMedGoogle Scholar
8.
Horimukai  K, Morita  K, Narita  M,  et al.  Application of moisturizer to neonates prevents development of atopic dermatitis.  J Allergy Clin Immunol. 2014;134(4):824-830. PubMedGoogle ScholarCrossref
9.
Simpson  EL, Chalmers  JR, Hanifin  JM,  et al.  Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention.  J Allergy Clin Immunol. 2014;134(4):818-823.PubMedGoogle ScholarCrossref
10.
Mosteller  RD.  Simplified calculation of body-surface area.  N Engl J Med. 1987;317(17):1098.PubMedGoogle Scholar
11.
WHO growth standards are recommended for use in the us for infants and children 0 to 2 years of age. The WHO Growth Charts. Centers for Disease Control and Prevention website. http://www.cdc.gov/growthcharts/who_charts.htm. Accessed June 3, 2016.
12.
Darmstadt  GL, Saha  SK, Ahmed  AS,  et al.  Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial.  Pediatrics. 2008;121(3):522-529.PubMedGoogle ScholarCrossref
13.
Silverberg  JI, Simpson  EL.  Associations of childhood eczema severity: a US population-based study.  Dermatitis. 2014;25(3):107-114. PubMedGoogle ScholarCrossref
14.
Scheman  A, Rakowski  EM.  Hyporeactive products 2015: an adjunct in the treatment of contact dermatitis and other chronic eczemas.  Dermatitis. 2015;26(6):293-295. PubMedGoogle ScholarCrossref
15.
Willemsen  MG, van Valburg  RW, Dirven-Miejer  PC, Oranje  AP, van der Wouden  JC, Moed  H.  Determining the severity of atopic dermatitis in children presenting in general practice: an easy and fast method.  Dermatol Res Pract. 2009;2009:357046. PubMedGoogle Scholar
16.
Garside  R, Stein  K, Castelnuovo  E,  et al.  The effectiveness and cost-effectiveness of pimecrolimus and tacrolimus for atopic eczema: a systematic review and economic evaluation.  Health Technol Assess. 2005;9(29). doi:10.3310/hta9290PubMedGoogle Scholar
17.
McCabe  C, Claxton  K, Culyer  AJ.  The NICE cost-effectiveness threshold: what it is and what that means.  Pharmacoeconomics. 2008;26(9):733-744.PubMedGoogle ScholarCrossref
18.
Ellis  CN, Drake  LA, Prendergast  MM,  et al.  Cost of atopic dermatitis and eczema in the United States.  J Am Acad Dermatol. 2002;46(3):361-370.PubMedGoogle ScholarCrossref
19.
Mancini  AJ, Kaulback  K, Chamlin  SL.  The socioeconomic impact of atopic dermatitis in the United States: a systematic review.  Pediatr Dermatol. 2008;25(1):1-6.PubMedGoogle ScholarCrossref
20.
Kelleher  MM, Dunn-Galvin  A, Gray  C,  et al.  Skin barrier impairment at birth predicts food allergy at 2 years of age.  J Allergy Clin Immunol. 2016;137(4):1111-1116.PubMedGoogle ScholarCrossref
21.
Deckert  S, Kopkow  C, Schmitt  J.  Nonallergic comorbidities of atopic eczema: an overview of systematic reviews.  Allergy. 2014;69(1):37-45.PubMedGoogle ScholarCrossref
22.
Silverberg  JI, Silverberg  NB, Lee-Wong  M.  Association between atopic dermatitis and obesity in adulthood.  Br J Dermatol. 2012;166(3):498-504.PubMedGoogle ScholarCrossref
23.
Strom  MA, Fishbein  AB, Paller  AS, Silverberg  JI.  Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults.  Br J Dermatol. 2016;175(5):920-929. PubMedGoogle ScholarCrossref
24.
Filanovsky  MG, Pootongkam  S, Tamburro  JE, Smith  MC, Ganocy  SJ, Nedorost  ST.  The financial and emotional impact of atopic dermatitis on children and their families.  J Pediatr. 2016;169:284-290. PubMedGoogle ScholarCrossref
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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