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)

Tracey Sach, K. S. Thomas, J. M. Batchelor, P. Akram, J. R. Chalmers, R. H. Haines, G. D. Meakin, Leila 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, Nick LevellJ. 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

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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.

Original languageEnglish
Pages (from-to)840-848
Number of pages9
JournalBritish Journal of Dermatology
Volume184
Issue number5
Early online date12 Sep 2020
DOIs
Publication statusPublished - May 2021

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