Skip to main content
SpringerLink
Log in

The Use of Decision–Analytic Models in Atopic Eczema: A Systematic Review and Critical Appraisal

  • Systematic Review
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Objective

The objective of this systematic review was to identify and assess the quality of published economic decision–analytic models within atopic eczema against best practice guidelines, with the intention of informing future decision–analytic models within this condition.

Methods

A systematic search of the following online databases was performed: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, EconLit, Scopus, Health Technology Assessment, Cost-Effectiveness Analysis Registry and Web of Science. Papers were eligible for inclusion if they described a decision–analytic model evaluating both the costs and benefits associated with an intervention or prevention for atopic eczema. Data were extracted using a standardised form by two independent reviewers, whilst quality was assessed using the model-specific Philips criteria.

Results

Twenty-four models were identified, evaluating either preventions (n = 12) or interventions (n = 12): 14 reported using a Markov modelling approach, four utilised decision trees and one a discrete event simulation, whilst five did not specify the approach. The majority, 22 studies, reported that the intervention was dominant or cost effective, given the assumptions and analytical perspective taken. Notably, the models tended to be short-term (16 used a time horizon of ≤1 year), often providing little justification for the limited time horizon chosen. The methodological and reporting quality of the studies was generally weak, with only seven studies fulfilling more than 50% of their applicable Philips criteria.

Conclusions

This is the first systematic review of decision models in eczema. Whilst the majority of models reported favourable outcomes in terms of the cost effectiveness of the new intervention, the usefulness of these findings for decision-making is questionable. In particular, there is considerable scope for increasing the range of interventions evaluated, for improving modelling structures and reporting quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Williams HC. Atopic eczema. BMJ. 1995;311(7015):1241–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Williams HC. Atopic dermatitis. N Engl J Med. 2005;352(22):2314–24.

    Article  CAS  PubMed  Google Scholar 

  3. Luoma R, Koivikko A, Viander M. Development of asthma, allergic rhinitis and atopic dermatitis by the age of five years: a prospective study of 543 newborns. Allergy. 1983;38(5):339–46.

    Article  CAS  PubMed  Google Scholar 

  4. Chamlin SL, Chren M-M. Quality-of-life outcomes and measurement in childhood atopic dermatitis. Immunol Allergy Clin North Am. 2010;30(3):281–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Williams H, et al. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008;121(4):947–954.e15.

    Article  Google Scholar 

  6. Kay J, et al. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol. 1994;30(1):35–9.

    Article  CAS  PubMed  Google Scholar 

  7. Herd R, et al. The cost of atopic eczema. Br J Dermatol. 1996;135(1):20–3.

    Article  CAS  PubMed  Google Scholar 

  8. Philips Z, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess. 2004;8(36):1–158.

    Article  PubMed  Google Scholar 

  9. Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.

    Article  Google Scholar 

  10. Sach TH, et al. Economic evidence for the prevention and treatment of atopic eczema: a protocol for a systematic review. Syst Rev. 2016;5(1):90.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Barton P, Bryan S, Robinson S. Modelling in the economic evaluation of health care: selecting the appropriate approach. J Health Serv Res Policy. 2004;9(2):110–8.

    Article  PubMed  Google Scholar 

  12. Briggs AH, Claxton K, Sculpher MJ. Decision modelling for health economic evaluation. New York: Oxford University Press; 2006.

    Google Scholar 

  13. Colgan S, Gold L, Wirth K, et al. The cost-effectiveness of universal newborn screening for bilateral permanent congenital hearing impairment: systematic review. Acad Pediatr. 2012;12(3):171–80.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Joensuu JT, et al. The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systematic review. PloS One. 2015;10(3):e0119683.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Boland A, Cherry MG, Dickson R. Doing a systematic review: a student’s guide. Thousand Oaks: Sage; 2013.

    Google Scholar 

  16. Shemilt I, Thomas J, Morciano M. A web-based tool for adjusting costs to a specific target currency and price year. Evid Policy. 2010;6(1):51–9.

    Article  Google Scholar 

  17. Iskedjian M, et al. Economic evaluation of a 100% whey-based partially hydrolyzed infant formula in the prevention of atopic dermatitis among Swiss children. J Med Econ. 2012;15(2):378–93.

    Article  PubMed  Google Scholar 

  18. Iskedjian M, et al. Economic evaluation of a 100% whey-based, partially hydrolysed formula in the prevention of atopic dermatitis among French children. Curr Med Res Opin. 2010;26(11):2607–26.

    Article  PubMed  Google Scholar 

  19. Iskedjian M, et al. Economic evaluation of a 100% whey-based partially hydrolyzed infant formula in the prevention of atopic dermatitis among Danish children. J Med Econ. 2012;15(2):394–408.

    Article  PubMed  Google Scholar 

  20. Su J, et al. Cost-effectiveness of partially-hydrolyzed formula for prevention of atopic dermatitis in Australia. J Med Econ. 2012;15(6):1064–77.

    Article  PubMed  Google Scholar 

  21. Abramovits W, Boguniewicz M, Prendergast MM, et al. Comparisons of efficacy and cost-effectiveness of topical immunomodulators in the management of atopic dermatitis. J Med Econ. 2003;6(1–14):1–14.

    Article  Google Scholar 

  22. Ellis CN, Drake LA, Prendergast MM, et al. Cost-effectiveness analysis of tacrolimus ointment versus high-potency topical corticosteroids in adults with moderate to severe atopic dermatitis. J Am Acad Dermatol. 2003;48(4):553–63.

    Article  PubMed  Google Scholar 

  23. Bhanegaonkar A, et al. Economic burden of atopic dermatitis in high-risk infants receiving cow’s milk or partially hydrolyzed 100% whey-based formula. J Pediatr. 2015;166(5):1145–1151.e3.

    Article  PubMed  Google Scholar 

  24. Bhanegaonkar AJ, Horodniceanu EG, Abdul Latiff AH, et al. Economic value of atopic dermatitis prevention via infant formula use in high-risk Malaysian infants. Asia Pac Allergy. 2015;5(2):84–97.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bhanegaonkar AJ, Horodniceanu BS, Rizalina RH, et al. Cost-effectiveness of partially hydrolyzed whey protein formula in the primary prevention of atopic dermatitis in at-risk urban Filipino infants. Value Health Reg Issues. 2014;3(1):124–35.

    Article  Google Scholar 

  26. Botteman M, Detzel P. Cost-effectiveness of partially hydrolyzed whey protein formula in the primary prevention of atopic dermatitis in high-risk urban infants in Southeast Asia. Ann Nutr Metab. 2015;66:26–32.

    Article  CAS  PubMed  Google Scholar 

  27. Pitt M, Garside R, Stein K. A cost-utility analysis of pimecrolimus vs. topical corticosteroids and emollients for the treatment of mild and moderate atopic eczema. Br J Dermatol. 2006;154(6):1137–46.

    Article  CAS  PubMed  Google Scholar 

  28. Garside R, Stein K, Castelnuovo E, et al. The effectiveness and cost-effectiveness of pimecrolimus and tacrolimus for atopic eczema: a systematic review and economic evaluation. Health Technol Assess. 2005;9(29):iii, xi–xiii, 1–230.

  29. de Tiedra A, Mercadal J, Lozano R. Prednicarbate versus fluocortin for inflammatory dermatoses. A cost-effectiveness study. Pharmacoeconomics. 1997;12(2 Pt 1):193–208.

    PubMed  Google Scholar 

  30. Kiencke P, Viehmann K, Rychlik R. Cost-effectiveness analysis, prevention of atopic dermatitis by oral application of bacterial lysate in newborns/small children. Eur J Health Econ. 2013;14(6):995–1002.

    Article  PubMed  Google Scholar 

  31. Mertens J, Stock S, Lüngen M, et al. Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany. Pediatr Allergy Immunol. 2012;23(6):597–604.

    Article  PubMed  Google Scholar 

  32. Coyle D, Barbeau M. Cost effectiveness of Elidel in the management of patients with atopic dermatitis in Canada. J Cutan Med Surg. 2004;8(6):405–10.

    Article  PubMed  Google Scholar 

  33. Ellis CN, Kahler KH, Grueger J, et al. Cost effectiveness of management of mild-to-moderate atopic dermatitis with 1% pimecrolimus cream in children and adolescents 2–17 years of age. Am J Clin Dermatol. 2006;7(2):133–9.

    Article  PubMed  Google Scholar 

  34. Healy E, et al. Cost-effectiveness of tacrolimus ointment in adults and children with moderate and severe atopic dermatitis: twice-weekly maintenance treatment vs. standard twice-daily reactive treatment of exacerbations from a third party payer (U.K. National Health Service) perspective. Br J Dermatol. 2011;164(2):387–95.

    Article  CAS  PubMed  Google Scholar 

  35. Hjalte F, Asseburg C, Tennvall GR. Cost-effectiveness of a barrier-strengthening moisturizing cream as maintenance therapy vs. no treatment after an initial steroid course in patients with atopic dermatitis in Sweden–with model applications for Denmark, Norway and Finland. J Eur Acad Dermatol Venereol. 2010;24(4):474–80.

    Article  CAS  PubMed  Google Scholar 

  36. Hjelmgren J, et al. Cost-effectiveness of tacrolimus ointment vs. standard treatment in patients with moderate and severe atopic dermatitis: a health-economic model simulation based on a patient survey and clinical trial data. Br J Dermatol. 2007;156(5):913–21.

    Article  CAS  PubMed  Google Scholar 

  37. Lenoir-Wijnkoop I, van Aalderen WM, Boehm G, et al. Cost-effectiveness model for a specific mixture of prebiotics in The Netherlands. Eur J Health Econ. 2012;13:101–10. doi:10.1007/s10198-010-0289-4.

    Article  CAS  PubMed  Google Scholar 

  38. Tang MBY, Leong KF, Ou LS, et al. Cost-effectiveness study of pediatric atopic dermatitis in Asia: atopiclair vs. regular emollient (AD-ATOP). J Drugs Dermatol. 2015;14(2):169–75.

    PubMed  Google Scholar 

  39. Norrlid H, Hjalte F, Lundqvist A, et al. Cost-effectiveness of maintenance treatment with a barrier-strengthening moisturizing cream in patients with atopic dermatitis in Finland, Norway and Sweden. Acta Derm Venereol. 2016;96(2):173–6.

    Article  PubMed  Google Scholar 

  40. Xu S, Immaneni S, Hazen GB, et al. Cost-effectiveness of prophylactic moisturization for atopic dermatitis. JAMA Pediatr. 2017;171(2):e163909.

    Article  PubMed  Google Scholar 

  41. Brennan A, Chick SE, Davies R. A taxonomy of model structures for economic evaluation of health technologies. Health Econ. 2006;15(12):1295–310.

    Article  PubMed  Google Scholar 

  42. Tappenden P, et al. Whole disease modeling to inform resource allocation decisions in cancer: a methodological framework. Value Health. 2012;15(8):1127–36.

    Article  PubMed  Google Scholar 

  43. Zhang W, et al. Systematic review of cost-effectiveness analyses of treatments for psoriasis. Pharmacoeconomics. 2015;33(4):327–40.

    Article  CAS  PubMed  Google Scholar 

  44. Siebert U, et al. State-transition modeling: a report of the ISPOR-SMDM modeling good research practices task force-3. Value Health. 2012;15(6):812–20.

    Article  PubMed  Google Scholar 

  45. Siegfried E, Korman N, Molina C, et al. Safety and efficacy of early intervention with pimecrolimus cream 1% combined with corticosteroids for major flares in infants and children with atopic dermatitis. J Dermatol Treat. 2006;17(3):143–50.

    Article  CAS  Google Scholar 

  46. Schmitt J, et al. The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol. 2014;134(4):800–7.

    Article  PubMed  Google Scholar 

  47. Weinstein MC, O’Brien B, Hornberger J, et al. ISPOR Task Force on Good Research Practices—Modeling Studies. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices—Modeling Studies. Value Health. 2003;6(1):9–17.

    Article  PubMed  Google Scholar 

  48. Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Mak. 1993;13(4):322–38.

    Article  CAS  Google Scholar 

  49. Cooper N, Coyle D, Abrams K, et al. Use of evidence in decision models: an appraisal of health technology assessments in the UK since 1997. J Health Serv Res Policy. 2005;10(4):245–50.

    Article  PubMed  Google Scholar 

  50. Leal J, Wordsworth S, Legood R, et al. Eliciting expert opinion for economic models: an applied example. Value Health. 2007;10(3):195–203.

    Article  PubMed  Google Scholar 

  51. Iglesias CP, et al. Reporting guidelines for the use of expert judgement in model-based economic evaluations. Pharmacoeconomics. 2016;34(11):1161–72.

    Article  PubMed  Google Scholar 

  52. Poole C, Chambers C, Sidhu MK, et al. Health-related utility among adults with atopic dermatitis treated with 0· 1% tacrolimus ointment as maintenance therapy over the long term: findings from the Protopic® CONTROL study. Br J Dermatol. 2009;161(6):1335–40.

    Article  CAS  PubMed  Google Scholar 

  53. Stevens K, Brazier JE, McKenna SP, et al. The development of a preference-based measure of health in children with atopic dermatitis. Br J Dermatol. 2005;153(2):372–7.

    Article  CAS  PubMed  Google Scholar 

  54. Francis NA, et al. A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study. Health Technol Assess. 2016;20(19):1–84.

    Article  PubMed Central  Google Scholar 

  55. Briggs AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 2000;17(5):479–500.

    Article  CAS  PubMed  Google Scholar 

  56. Vemer P, et al. AdViSHE: a validation-assessment tool of health-economic models for decision makers and model users. Pharmacoeconomics. 2016;34(4):349–61.

    Article  CAS  PubMed  Google Scholar 

  57. Shearer J, et al. The use of decision-analytic models in Parkinson’s disease. Appl Health Econ Health Pol. 2011;9(4):243–58.

    Article  Google Scholar 

  58. Vaidya A, Joore MA, ten Cate-Hoek AJ, et al. A systematic review of model-based economic evaluations of diagnostic and therapeutic strategies for lower extremity artery. Thromb Haemost. 2014;2014(111):19–28.

    Google Scholar 

  59. Nankervis H, Maplethorpe A, Williams HC. Mapping randomized controlled trials of treatments for eczema-The GREAT database (The Global Resource of Eczema Trials: a collection of key data on randomized controlled trials of treatments for eczema from 2000 to 2010). BMC Dermatol. 2011;11(1):10.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Madan J, et al. Consensus decision models for biologics in rheumatoid and psoriatic arthritis: recommendations of a multidisciplinary working party. Rheumatol Ther. 2015;2(2):113–25.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The following individuals are acknowledged as providing advice as research mentors (Professor Kim Thomas, Dr Nicky Welton, Professor Andrew Briggs), as part of the annual advisory panel (Dr Tom Kenny, Fiona McOwan, Jo Parris, Amanda Roberts, Professor Lee Shepstone, Professor Fujian Song and Dr Edward Wilson) and for contributing to the search strategy and data extraction (Mr Christopher McMonagle).

Author information

Authors and Affiliations

  1. Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK

    Emma McManus & Tracey Sach

  2. Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK

    Nick Levell

Authors
  1. Emma McManus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tracey Sach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nick Levell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tracey Sach.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interests.

Funding

This work was funded as part of Professor Tracey Sach’s Career Development Fellowship (CDF award-2014-07-006) supported by the National Institute for Health Research (NIHR). Further support was also received from the NIHR Collaboration for Leadership in Applied Health Research and Care East (NIHR CLAHRC EoE). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Author Contributions

EM contributed to the design of the study, carried out the searches, screening and data extraction, contributed to interpretation of data, and drafted and critically reviewed the paper. TS contributed to the design of the study, carried out the screening and data extraction, contributed to interpretation of data, and drafted and critically reviewed the paper. NL contributed to the design of the study and critically reviewed the paper.

Data Availability Statement

The search strategy used to conduct the systematic literature search is published elsewhere [10]. The unpopulated data extraction form used within this review, as well as the quality assessment form based on the Philips criteria can be found in Electronic Supplementary Material 1. The completed data extraction table for all of the studies included within this review can be found in Electronic Supplementary Material 2.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 28 kb)

Supplementary material 2 (DOCX 58 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McManus, E., Sach, T. & Levell, N. The Use of Decision–Analytic Models in Atopic Eczema: A Systematic Review and Critical Appraisal. PharmacoEconomics 36, 51–66 (2018). https://doi.org/10.1007/s40273-017-0564-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-017-0564-7

Search

Navigation