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)

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 = 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. Copyright © 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.