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Publications

Journal Article Epublish

PubMed: 42540011 DOI: 10.1093/skinhd/vzag042

Healthcare resource use, costs and health-related quality of life in the UK-Irish Atopic eczema Systemic Therapy Register (A-STAR): a pilot study.

Skin Health Dis 6(4):459-467

Authors: Carlos Chivardi, Elizaveta Gribaleva, Bolaji Coker, Man Fung Tsoi, Rebecca Carroll, David Prieto Merino, Manisha Baden, Paula E Beattie, Sara J Brown, Tim Burton, Ross Hearn, John R Ingram, Alan D Irvine, Graham A Johnston, Irene Man, Graham Ogg, Mandy Wan, Richard B Warren, Richard T Woolf, Nick J Reynolds, Michael R Ardern-Jones, Carsten Flohr, Andrea Manca

Affiliations

  • Centre for Health Economics, University of York, York, UK.
  • A-STAR Register Coordinating Centre, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
  • Research and Development Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain.
  • Department of Dermatology, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK.
  • Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK.
  • Patient Representative (independent), Nottingham, UK.
  • Department of Dermatology and Photobiology, Ninewells Hospital, Dundee, UK.
  • Department of Dermatology, Division of Infection and Immunity, Cardiff University, Cardiff, UK.
  • Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
  • Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK.
  • Department of Dermatology, Surrey and Sussex Healthcare NHS Trust, Surrey, UK.
  • MRC Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
  • Evelina London Children's Hospital, Guys' and St Thomas' NHS Foundation Trust, London, UK.
  • Institute of Pharmaceutical Science, King's College London, London, UK.
  • Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
  • Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
  • St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Institute of Translational and Clinical Medicine, Newcastle University Medical School and Department of Dermatology and the Newcastle NIHR Biomedical Research Centre, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
  • Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.

Abstract

BACKGROUND

Managing patients with moderate-to-severe atopic eczema (AE) is challenging. Novel systemic immunomodulatory therapies are effective but costly, whereas conventional treatments require more intense safety monitoring. While available randomized trials assess efficacy, they do not reflect real-world practice or cost-effectiveness. The UK-Irish Atopic Eczema Systemic Therapy Register (A-STAR) was established to generate real-world evidence on systemic AE treatments.

OBJECTIVES

To assess healthcare resource utilization, costs and health-related quality of life (HRQoL) over 1 year in participants in A-STAR, and to evaluate data quality in a pilot analysis.

METHODS

A-STAR is a multicentre prospective register that recruits paediatric (aged <16 years) and adult (aged ≥16 years) patients with AE who are initiating or switching systemic immunomodulatory therapy. Healthcare utilization [general practitioner (GP) visits, accident and emergency (A&E) department attendance, hospitalizations, specialist consultations and therapy costs] was valued using national average unit costs and tariffs. HRQoL was measured with the EuroQol 5 Dimension (EQ-5D).

RESULTS

Of 120 participants (92 adults and 28 children) with a median follow-up to 12 months, adults had higher mean healthcare costs per year than children, including A&E (£120.41 vs. £84.29), GP (£111.15 vs. £78.46) and specialist (£205.17 vs. £121.00) visits. Mean (SD) systemic therapy costs per year were £25 523 (£24 424) in adults and £20 242 (£18 994) in children, averaged across all treatment options. Mean EQ-5D scores improved from baseline to 1 year (from 0.608 to 0.769 in adults and from 0.482 to 0.751 in children).

CONCLUSIONS

Systemic therapy improved HRQoL but incurred notable costs. A-STAR is well positioned to support future comparative economic evaluations of alternative treatment strategies to inform clinical and reimbursement decisions.

MeSH

Pilot Projects, Quality Of Life, Pilots, Immunomodulation, Eczema, Aged, Therapeutics, Child, Dermatitis, Atopic