What Is The Scope And Quality of Economic Evidence Available for Atopic Eczema? A Systematic Review

OBJECTIVES: Atopic eczema is a chronic inflammatory skin disease, resulting in itchy, dry skin. Whilst the clinical effectiveness evidence for eczema is collated in the Global Resource of Eczema Trials (GREAT) database there is currently no such resource for economic evidence. Therefore, we undertook a systematic review with the aim of identifying the scope and quality of economic research for atopic eczema. METHODS: A systematic literature search was conducted on 22nd May 2017. Studies eligible for inclusion were primary empirical studies either reporting the results of a cost of illness study or evaluating the cost, utility or full economic evaluation of preventions or interventions for eczema. Two reviewers independently assessed studies for eligibility and performed data abstraction collecting details of the study characteristics, costing and outcome methods, and quality assessment. Methodological quality was assessed using the CHEERS checklist. Further details can be found on PROSPERO (CRD42015024633). RESULTS: 11 studies were found, of which 33 (42.9%) were judged to be full economic evaluations, 26 (33.8%) were cost of illness studies, 12 (15.6%) were cost analyses, 5 (6.5%) were utility or willingness to pay studies, and one (1.3%) was a feasibility study. The interventions: tacrolimus, pimecrolimus, and barrier creams had the most economic evidence available (19 studies). Partially hydrolysed infant formula was the most commonly evaluated prevention (10 studies). The time frame for analyses ranged from 3 weeks to 14 years. According to the CHEERS checklist, the studies were of reasonable reporting quality with the majority of studies fulfilling more than 70% of criteria. CONCLUSIONS: The current level of economic evidence within eczema is much lower than that available for clinical outcomes. The limited range of interventions evaluated and the heterogeneity of methods used in the existing evidence suggest further economic research is needed to support commissioners making health funding decisions.