Healthcare resource use, costs and health-related quality of life in the UK–Irish Atopic eczema Systemic Therapy Register (A-STAR): a pilot study

Background

Managing patients with moderate-to-severe atopic eczema (AE) is challenging. Novel systemic immunomodulatory therapies are effective but costly, whereas conventional treatments require more intense safety monitoring. While available randomized trials assess efficacy, they do not reflect real-world practice or cost-effectiveness. The UK–Irish Atopic Eczema Systemic Therapy Register (A-STAR) was established to generate real-world evidence on systemic AE treatments.

Objectives

To assess healthcare resource utilization, costs and health-related quality of life (HRQoL) over 1 year in participants in A-STAR, and to evaluate data quality in a pilot analysis.

Methods

A-STAR is a multicentre prospective register that recruits paediatric (aged <16 years) and adult (aged ≥16 years) patients with AE who are initiating or switching systemic immunomodulatory therapy. Healthcare utilization [general practitioner (GP) visits, accident and emergency (A&E) department attendance, hospitalizations, specialist consultations and therapy costs] was valued using national average unit costs and tariffs. HRQoL was measured with the EuroQol 5 Dimension (EQ-5D).

Results

Of 120 participants (92 adults and 28 children) with a median follow-up to 12 months, adults had higher mean healthcare costs per year than children, including A&E (£120.41 vs. £84.29), GP (£111.15 vs. £78.46) and specialist (£205.17 vs. £121.00) visits. Mean (SD) systemic therapy costs per year were £25 523 (£24 424) in adults and £20 242 (£18 994) in children, averaged across all treatment options. Mean EQ-5D scores improved from baseline to 1 year (from 0.608 to 0.769 in adults and from 0.482 to 0.751 in children).

Conclusions

Systemic therapy improved HRQoL but incurred notable costs. A-STAR is well positioned to support future comparative economic evaluations of alternative treatment strategies to inform clinical and reimbursement decisions.