Cost-Effectiveness Study of Pediatric Atopic Dermatitis in Asia: Atopiclair vs. Regular Emollient (AD-ATOP)
February 2015 | Volume 14 | Issue 2 | Original Article | 169 | Copyright © 2015
Mark B.Y. Tang FRCP MRCP MMed MBBS,1 Kin Fon Leong MRCPCH MBBS,2 Liang-Shiou Ou MD,3
Zakiudin Munasir MD,4 Pankaj R. Parekh MD DCH,5 Soraya Azmi MPH MBBS,6
Wilson H.H. Low MSc BSc,6 and Adrian Goh MEc BEc6
1National Skin Centre, Singapore
2Pediatric Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
3Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University,
4Pediatric Allergy Immunology Division, Department of Child Health, Medical Faculty, University of Indonesia, Jakarta, Indonesia
5Cheers Child Care, Kemps Corner, Mumbai, India
6Veras Research, Petaling Jaya, Malaysia
BACKGROUND: Atopic dermatitis (AD) is a highly prevalent, chronic relapsing condition in childhood with significant financial burden
and impact on the quality of life of patients and caregivers. Proactive maintenance treatment with moisturizing agents is the mainstay
AD therapy. Objectives: The aim of this study was to assess the cost-effectiveness of a non-steroidal barrier cream (Atopiclair),
compared to regular emollient in pediatric patients with mild-to-moderate AD. Methods: A Markov decision model was developed
to evaluate the cost-effectiveness of Atopiclair versus regular emollient in 12 Asia-Pacific countries, grouped by income categories
based on gross domestic product (GDP) per capita. Data was obtained from structured literature review, expert opinion, fee schedules,
and findings from a 2012 survey of 12 Asia-Pacific countries. Analysis was performed a societal perspective. Results: In the
base case analysis, Atopiclair was cost-effective against regular emollient, with USD786, USD499, and USD289 in cost savings per
year for high, middle, and low-income countries, respectively. Sensitivity analyses showed that Atopiclair remained cost-effective
versus regular emollient. Conclusions: Modelling analysis showed that Atopiclair is a cost-effective treatment compared to regular
emollient for mild-to-moderate pediatric AD in the countries included in the study.
J Drugs Dermatol. 2015;14(2):169-175.
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Atopic dermatitis (AD) is a chronic inflammatory dermatosis with increasing prevalence globally.1-4 Skin barrier repair with moisturizers is the mainstay treatment for AD, especially in the maintenance phase to prevent disease flares.5 Besides regular emollients containing humectants (eg, lactate, glycerine, and urea) specialized nonsteroidal topical barrier-protection creams (STC), have been developed to provide clinical benefits beyond regular moisturizers. 5,6 One such STC is Atopiclair® (Sinclair Pharma/A. Menarini Asia Pacific), a hydrolipidic cream that contains 2% glycyrrhetinic acid, hyaluronic acid, vitis vinifera (grapevine) extract, telmestine, and butyrospermum parkii (shea butter), which promote epidermal barrier repair and have antiinflammatory and anti-pruritic actions.7 While clinical trials had shown that STCs have greater efficacy compared to their vehicle base or basic emollients,8-11 it is unclear if STCs, which are generally costlier compared to regular emollients, are a cost-effective option for AD patients.12 Although the cost-effectiveness of pharmaceutical AD treatments such as topical tacrolimus,13-15 pimecrolimus,16-18 and corticosteroids18,19 have been demonstrated in North America and Europe, the costeffectiveness of STC has not been examined to a great extent.
Although the pattern of AD has been described in the Asia-Pacific region, evidence is limited and AD management practices vary across countries.20,21 A review in developed countries had shown that AD management costs vary widely by disease severity. 22 Information on cost of AD in Asia-Pacific is also scarce. In 2012, a survey was conducted to elicit the disease burden, quality of life (QOL) and cost of AD across 12 Asia-Pacific countries. 23-25 The survey assessed the impact of AD on QOL and financial cost on 1028 parents of children (1 to 16 years) with moderate to severe AD. It showed that at least 42.7% of patients experienced 5 or more flare-ups annually with frequent visits to general practitioners (GPs) and specialists.25 Furthermore, the child’s QOL was positively associated with AD severity, more so in low-income countries.24 Poorer QOL for the child also correlated with greater negative family impact.24