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Prophylactic Moisturizing for Atopic Dermatitis Is Cost-Effective
abstract
This abstract is available on the publisher's site.
Access this abstract nowImportance
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.
Additional Info
Disclosure statements are available on the authors' profiles:
Cost-Effectiveness of Prophylactic Moisturization for Atopic Dermatitis
JAMA Pediatr 2016 Dec 05;[EPub Ahead of Print], S Xu, S Immaneni, GB Hazen, JI Silverberg, AS Paller, PA LioFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Atopic dermatitis (AD) is a terrible disease that continues to vex patients and their healthcare providers. Although we are on the brink of what appears to be a new dawn for AD topical and systemic therapeutics, it is clear that these advances will be associated with significant costs and side effects.
The compelling work by Dr. Eric Simpson suggests that AD can be prevented, at least in some cases, simply by applying moisturizing lotions. This article explores the economic ramifications of preventing AD by using relatively safe and inexpensive over-the-counter moisturizers on high-risk newborns. While admittedly based on a series of imperfect assumptions, the final calculations paint a striking picture: all of the moisturizers, with the possible exception of the most expensive, were found to meet the National Institute for Health and Care Excellence of the United Kingdom’s threshold for cost-effectiveness.
Although it is somewhat perilous to quantify pain and suffering, an opportunity to prevent this disease is likely worth far more than even the best temporizing treatments to those afflicted. It is certainly worth getting excited about the possibility that this could be accomplished with affordable, safe moisturizers such as petrolatum or sunflower seed oil!