The UK Dermatology Clinical Trials Network BLISTER Study Group (Including: Mason, James, Chalmers, J. R., Godec, T., Nunn, A. J., Kirtschig, G., Wojnarowska, F., Childs, M., Whitham, D., Schmidt, E., Harman, K, Walton, S., Chapman, A. and Williams, H. C.). (2018) Doxycycline compared to prednisolone therapy for patients with bullous pemphigoid : cost-effectiveness analysis of the BLISTER trial. British Journal of Dermatology, 178 (2). pp. 415-423. doi:10.1111/bjd.16006

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Abstract

Background:
Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomised controlled trial (RCT).

Objectives:
To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP.

Methods:
a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective

Results:
In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline-initiated therapy with prednisolone-initiated therapy (net cost: £959, 95% CI –£24 to £1941; net QALYs: –0.024, 95% CI –0.088 to 0.041). However, findings varied by baseline blister severity. For patients with mild or moderate blistering (≤30) net costs and outcomes were similar. For patients with severe blistering (>30) net costs were higher (£2558, 95% CI –£82 to £5198) and quality of life poorer (–0.090 QALYs, 95% CI–0.222 to 0.042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1.5% at a willingness to pay of £20,000/QALY.

Conclusions:
Consistent with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering.

Item Type:	Journal Article
Subjects:	R Medicine > RL Dermatology
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Blisters -- Treatment -- Cost effectiveness, Autoimmune diseases -- Treatment -- Cost effectiveness
Journal or Publication Title:	British Journal of Dermatology
Publisher:	Wiley-Blackwell Publishing Ltd.
ISSN:	0007-0963
Official Date:	February 2018
Dates:	Date Event February 2018 Published 22 September 2017 Available 22 September 2017 Accepted
Date of first compliant deposit:	22 November 2017
Volume:	178
Number:	2
Page Range:	pp. 415-423
DOI:	10.1111/bjd.16006
Status:	Peer Reviewed
Publication Status:	Published
Publisher Statement:	** From Crossref via Jisc Publications Router.
Access rights to Published version:	Open Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Health Technology Assessment programme http://dx.doi.org/10.13039/501100000664

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