An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial)

T H Sach; K S Thomas; J M Batchelor; A Perways; J R Chalmers; R H Haines; G D Meakin; L Duley; J C Ravenscroft; A Rogers; M Santer; W Tan; J White; M E Whitton; H C Williams; S T Cheung; H Hamad; A Wright; J R Ingram; N Levell; J M R Goulding; A Makrygeorgou; A Bewley; M Ogboli; J Stainforth; A Ferguson; B Laguda; S Wahie; R Ellis; J Azad; A Rajasekaran; V Eleftheriadou; A A Montgomery; UK Dermatology Clinical Trials Network’s HI-Light Vitiligo Trial Team

doi:10.1111/bjd.19554

An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial)

Br J Dermatol. 2021 May;184(5):840-848. doi: 10.1111/bjd.19554. Epub 2020 Nov 4.

Authors

T H Sach¹, K S Thomas², J M Batchelor², A Perways³, J R Chalmers², R H Haines⁴, G D Meakin⁴, L Duley⁴, J C Ravenscroft⁵, A Rogers³, M Santer⁶, W Tan⁴, J White⁴, M E Whitton², H C Williams², S T Cheung⁷, H Hamad⁷, A Wright⁸, J R Ingram⁹, N Levell¹⁰, J M R Goulding¹¹, A Makrygeorgou¹², A Bewley¹³, M Ogboli¹⁴, J Stainforth¹⁵, A Ferguson¹⁶, B Laguda¹⁷, S Wahie¹⁸, R Ellis¹⁹, J Azad¹⁹, A Rajasekaran²⁰, V Eleftheriadou²¹, A A Montgomery⁴; UK Dermatology Clinical Trials Network’s HI-Light Vitiligo Trial Team

Affiliations

¹ Norwich Medical School, University of East Anglia, Norwich, UK.
² Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
³ Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK.
⁴ Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.
⁵ Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
⁶ Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, UK.
⁷ Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
⁸ St Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
⁹ Division of Infection and Immunity, Cardiff University, Cardiff, UK.
¹⁰ Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
¹¹ Solihull Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK.
¹² West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.
¹³ Whipps Cross Hospital and The Royal London Hospital, Barts Health NHS Trust, London, UK.
¹⁴ Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
¹⁵ York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK.
¹⁶ Royal Derby Hospital and the London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
¹⁷ Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
¹⁸ University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK.
¹⁹ The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
²⁰ Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
²¹ Leicester Royal Infirmary, Leicester, UK.

PMID: 32920824
DOI: 10.1111/bjd.19554

Abstract

Background: Economic evidence for vitiligo treatments is absent.

Objectives: To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo.

Methods: Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015.

Results: The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment.

Conclusions: Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones
Adult
Child
Combined Modality Therapy
Cost-Benefit Analysis
Humans
Treatment Outcome
Ultraviolet Therapy*
Vitiligo* / drug therapy

An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial)

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