Evidence map›Paper›PMID 30373584›Full record

ArticleBMC dermatology2018

Cost and effectiveness of prescribing emollient therapy for atopic eczema in UK primary care in children and adults: a large retrospective analysis of the Clinical Practice Research Datalink.

George Moncrieff, Annie Lied-Lied, Gill Nelson, Chantal E Holy, Rachel Weinstein, David Wei, Simon Rowe

Open access · diamondAbstract read
In one paragraph

Article in BMC dermatology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.4field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 14 citations in OpenAlex.

  1. Article
  2. Review
  3. Review
  4. Article
  5. Atopic Eczema in Adulthood and Risk of Depression and Anxiety: A Population-Based Cohort Study.The journal of allergy and clinical immunology. In practice · 2020
    Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 2 countries.

George MoncrieffMayfield Clinic Summertown, Oxford, OX2 7DE, UK. georgemoncrieff@hotmail.com.
Annie Lied-LiedJohnson & Johnson Ltd (UK), Maidenhead, Berkshire, UK.
Gill NelsonJohnson & Johnson Ltd (UK), Maidenhead, Berkshire, UK.
Chantal E HolyJohnson & Johnson, Inc, New Brunswick, NJ, USA.
Rachel WeinsteinJanssen Research and Development, LLC, Titusville, NJ, USA.
David WeiJohnson & Johnson, Inc, New Brunswick, NJ, USA.
Simon RoweNHS Wakefield Clinical Commissioning Group, West Yorkshire, UK.
Johnson & Johnson (United Kingdom) · GBJohnson & Johnson (United States) · USJanssen (United States) · USSouth West Yorkshire Partnership NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Clinical Practice Research Datalink (CPRD) was used to evaluate the overall costs to the National Health Service, including healthcare utilisation, of prescribing emollients in UK primary care for dry skin and atopic eczema (DS&E).

methodsPrimary care patients in the UK were identified using the CPRD and their records were interrogated for the 2 years following first diagnosis of DS&E. Data from patients with (n = 45,218) and without emollient prescriptions (n = 9780) were evaluated. Multivariate regression models were used to compare healthcare utilisation and cost in the two matched groups (age, sex, diagnosis). Two sub-analyses of the Emollient group were performed between matched groups receiving (1) a colloidal oatmeal emollient (Aveeno-First) versus non-colloidal oatmeal emollients (Aveeno-Never) and (2) Aveeno prescribed first-line (Aveeno-First) versus prescribed Aveeno later (Aveeno-Subsequently). Logistic regression models calculated the odds of prescription with either potent / very potent topical corticosteroids (TCS) or skin-related antimicrobials.

resultsCosts per patient were £125.80 in Emollient (n = 7846) versus £128.13 in Non-Emollient (n = 7846) matched groups (p = 0.08). The Emollient group had fewer visits/patient (2.44 vs. 2.66; p < 0.0001) and lower mean per-visit costs (£104.15 vs. £113.25; p < 0.0001), compared with the Non-Emollient group. Non-Emollient patients had 18% greater odds of being prescribed TCS and 13% greater odds of being prescribed an antimicrobial than Emollient patients. In the Aveeno-First (n = 1943) versus Aveeno-Never (n = 1943) sub-analysis, costs per patient were lower in the Aveeno-First compared with the Aveeno-Never groups (£133.46 vs. £141.11; p = 0.0069). The Aveeno-Never group had ≥21% greater odds of being prescribed TCS or antimicrobial than the Aveeno-First group. In the Aveeno-First (n = 1357) versus Aveeno-Subsequently (n = 1357) sub-analysis, total costs were lower in the Aveeno-First group (£140.35 vs. £206.43; p < 0.001). Patients in the Aveeno-Subsequently group had 91% greater odds of being prescribed TCS and 75% greater odds of being prescribed an antimicrobial than the Aveeno-First group.

conclusionsAcknowledging limitations from unknown disease severity in the CRPD, the prescription of emollients to treat DS&E was associated with fewer primary care visits, reduced healthcare utilisation and reduced cost. Prescribing emollients, especially those containing colloidal oatmeal, was associated with fewer TCS and antimicrobial prescriptions.

trial registrationThe study is registered at http://isrctn.com/ISRCTN91126037 .

Indexed as

AdolescentAdultAgedAvenaChildChild, PreschoolColloidsCost-Benefit AnalysisDatabases, FactualDermatitis, AtopicEmollientsFemaleHumansInfantLogistic ModelsMaleColloidsEmollientsAntimicrobialAtopic dermatitisColloidal oatmealCPRDEczemaEmollientHealthcare utilisationTopical steroid

Identifiers

PMID30373584
PMCPMC6206824
OpenAlexW2898677035

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.