Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
PharmacoEconomics
Published in: PharmacoEconomics 6/2005

01-06-2005 | Review Article

The economics of topical immunomodulators for the treatment of atopic dermatitis

Authors: William Abramovits, Mark Boguniewicz, Amy S. Paller, Diane L. Whitaker-Worth, Mary M. Prendergast, Michael Tokar, Kuo B. Tong

Published in: PharmacoEconomics | Issue 6/2005

Login to get access

Abstract

Atopic dermatitis is a common, chronic, relapsing inflammatory skin disease frequently affecting infants and children. The worldwide prevalence of atopic dermatitis is estimated to be 5–20% of the paediatric population. First-line therapy has generally consisted of dry skin care, avoidance of triggers, application of topical corticosteroids, and administration of antihistamines and oral antibacterials. Topical corticosteroids improve the lesions of atopic dermatitis; however, concern on the part of physicians and patients regarding adverse effects has led to reluctance to utilise topical corticosteroids early and especially for prolonged periods. Topical immunomodulators (TIMs), including tacrolimus ointment and pimecrolimus cream, were recently introduced for the treatment of atopic dermatitis.
Clinical data show that TIMs are effective in atopic dermatitis, yet do not cause the significant adverse effects associated with topical corticosteroids. Questions remain regarding the place of TIMs as a treatment for atopic dermatitis and how to use them most effectively, from both therapeutic and pharmacoeconomic standpoints. Specifically, two major issues remain unresolved: (i) how TIMs measure up to other therapies, especially topical corticosteroids; and (ii) how members of the TIM drug class compare against each other.
Previous research has established that atopic dermatitis has a significant impact on quality of life (QOL) and carries a substantial economic burden. Some studies have also measured the utility of various atopic dermatitis disease states. While there is a need for further research, early economic studies provide evidence that TIMs positively affect the QOL of patients and families. In certain patients, TIMs may be cost effective and have an acceptable incremental cost utility compared with topical corticosteroids.
Making cost-effectiveness comparisons between tacrolimus and pimecrolimus is challenging because there are limited head-to-head comparative data. Given currently available efficacy data, the results of one study suggest that tacrolimus may be more cost effective than pimecrolimus in paediatric patients with moderate atopic dermatitis.
The full economic and QOL benefits of both agents are yet to be completely understood. The studies reviewed herein are the first to delineate the pharmacoeconomic benefits of TIMs in atopic dermatitis, and lay the foundation for future analyses. TIMs represent an exciting advance in the treatment of atopic dermatitis. Additional research will help determine the proper place of TIMs among the current array of therapeutic options for atopic dermatitis.
Literature
1.
Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999 Jan; 103 (1 Pt 1): 125–38PubMedCrossRef
2.
Schultz Larsen F, Diepgen T, Svensson A. The occurrence of atopic dermatitis in north Europe: an international questionnaire study. J Am Acad Dermatol 1996 May; 34 (5 Pt 1): 760–4PubMedCrossRef
3.
Laughter D, Istvan JA, Tofte SJ, et al. The prevalence of atopic dermatitis in Oregon schoolchildren. J Am Acad Dermatol 2000 Oct; 43 (4): 649–55PubMedCrossRef
4.
Sugiura H, Umemoto N, Deguchi H, et al. Prevalence of childhood and adolescent atopic dermatitis in a Japanese population: comparison with the disease frequency examined 20 years ago. Acta Derm Venereol 1998 Jul; 78 (4): 293–4PubMedCrossRef
5.
Ellis C, Drake L, Prendergast M, et al. Cost of atopic dermatitis and eczema in the United States. J Am Acad Dermatol 2002 Mar; 46: 361–70
6.
Boguniewicz M, Leung DYM. Pathophysiologic mechanisms in atopic dermatitis. Semin Cutan Med Surg 2001; 20 (4): 217–25PubMedCrossRef
7.
Leung DY, Soter NA. Cellular and immunologic mechanisms in atopic dermatitis. J Am Acad Dermatol 2001 Jan; 44 (1 Suppl.): S1–12PubMedCrossRef
8.
9.
Boguniewicz M, Leung DY. Atopic dermatitis. In: Middleton E, Ellis EF, Yunginger JW, et al., editors. Allergy: principles and practice, 5th ed. St Louis (MO): Mosby, 1998: 1123–31
10.
Correale CE, Walker C, Murphy L, et al. Atopic dermatitis: a review of diagnosis and treatment. Am Fam Physician 1999 Sep 15; 60 (4): 1191–8, 1209–10PubMed
11.
Tofte SJ, Hanifin JM. Current management and therapy of atopic dermatitis. J Am Acad Dermatol 2001 Jan; 44 (1 Suppl.): S13–6PubMedCrossRef
12.
Ellis C, Luger T, Abeck D, et al. International Consensus Conference on Atopic Dermatitis II (ICCAD II): clinical update and current treatment strategies. Br J Dermatol 2003 May; 148 Suppl. 63: S3–10CrossRef
13.
Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000; 4 (37): 1–191PubMed
14.
Reitamo S, Van Leent EJ, Ho V, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis. J Allergy Clin Immunol 2002 Mar; 109 (3): 539–46PubMedCrossRef
15.
Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000 May; 142 (5): 931–6PubMedCrossRef
16.
Harper JI, Ahmed I, Barclay G, et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. Br J Dermatol 2000 Jan; 142 (1): 52–8PubMedCrossRef
17.
Klasco RK, Gelman CR, editors. USP DI® drug information for the healthcare professional. Greenwood Village (CO): Micromedex, 2003
18.
De Rie MA, Meinardi MM, Bos JD. Lack of efficacy of topical cyclosporin A in atopic dermatitis and allergic contact dermatitis. Acta Derm Venereol 1991; 71 (5): 452–4PubMed
19.
Bekersky I, Fitzsimmons W, Tanase A, et al. Nonclinical and early clinical development of tacrolimus ointment for the treatment of atopic dermatitis. J Am Acad Dermatol 2001 Jan; 44 (1 Suppl.): S17–27PubMedCrossRef
20.
Nghiem P, Pearson G, Langley RG. Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol 2002 Feb; 46 (2): 228–41PubMedCrossRef
21.
Red book, Montvale (NJ): Medical Economics, 2004 Jan
22.
Hanifin JM, Ling MR, Langley R, et al. Tacrolimus ointment for the treatment of atopic dermatitis in adult patients: part I. Efficacy. J Am Acad Dermatol 2001 Jan; 44 (1 Suppl.): S2838
23.
Paller A, Eichenfield LF, Leung DY, et al. A 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 2001 Jan; 44 (1 Suppl.): S47–57PubMedCrossRef
24.
Boguniewicz M, Fiedler VC, Rainier S, et al. A randomized, vehicle-controlled trial of tacrolimus ointment for treatment of atopic dermatitis in children. Pediatric Tacrolimus Study Group. J Allergy Clin Immunol 1998 Oct; 102 (4 Pt 1): 637–44PubMedCrossRef
25.
Ruzicka T, Bieber T, Schopf E, et al. A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group. N Engl J Med 1997; 337 (12): 816–21PubMedCrossRef
26.
Reitamo S, Rustin M, Ruzicka T, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis. J Allergy Clin Immunol 2002 Mar; 109 (3): 557–5
27.
Kang S, Lucky AW, Pariser D, et al. Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children. J Am Acad Dermatol 2001 Jan; 44 (1 Suppl.): S58–64PubMedCrossRef
28.
Reitamo S, Wollenberg A, Schopf E, et al. Safety and efficacy of 1 year of tacrolimus ointment monotherapy in adults with atopic dermatitis. The European Tacrolimus Ointment Study Group. Arch Dermatol 2000; 136 (8): 999–1006CrossRef
29.
Hanifin JM, Leung DY, Paller A, et al. Tacrolimus ointment monotherapy is safe and effective for the long-term treatment (more than 3 years) of atopic dermatitis in pediatric patients [abstract]. American Academy of Allergy, Asthma and Immunology 60th Anniversary Meeting; 2003 Mar 7–12; Denver. 244
30.
Koo JY, Fleischer A, Pariser D, et al. Tacrolimus ointment 0.1 % is safe and effective in the treatment for atopic dermatitis: final results of a large (over 7,000 patients) open-label study [ab stract]. American Academy of Dermatology Conference; 2003 Mar 21–26; San Francisco. P22
31.
Ho VC, Gupta A, Kaufmann R, et al. Safety and efficacy of nonsteroid pimecrolimus cream 1% in the treatment of atopic dermatitis in infants. J Pediatr 2003 Feb; 142 (2): 155–62PubMedCrossRef
32.
Wahn U, Bos JD, Goodfield M, et al. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children. Pediatrics 2002 Jul; 110 (1 Pt 1): e2PubMedCrossRef
33.
Kapp A, Papp K, Bingham A, et al. Long-term management of atopic dermatitis in infants with topical pimecrolimus, a nonsteroid anti-inflammatory drug. J Allergy Clin Immunol 2002 Aug; 110 (2): 277–84PubMedCrossRef
34.
Eichenfield LF, Lucky AW, Boguniewicz M, et al. Safety and efficacy of pimecrolimus (ASM 981) cream I% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol 2002 Apr; 46 (4): 495–504PubMedCrossRef
35.
Luger T, Van Leent EJ, Graeber M, et al. SDZ ASM 981: an emerging safe and effective treatment for atopic dermatitis. Br J Dermatol 2001 Apr; 144 (4): 788–94PubMedCrossRef
36.
Harper J, Green A, Scott G, et al. First experience of topical SDZ ASM 981 in children with atopic dermatitis. Br J Dermalot 2001 Apr; 144 (4): 781–7CrossRef
37.
Queille-Roussel C, Paul C, Duteil L, et al. The new topical ascomycin derivative SDZ ASM 981 does not induce skin atrophy when applied to normal skin for 4 weeks: a random ized, double-blind controlled study. Br J Dermatol 2001 Mar; 144 (3): 507–13PubMedCrossRef
38.
Soler NA, Fleischer Jr AB, Webster GF, et al. Tacrolimus ointment for the treatment of atopic dermatitis in adult patients: part II, safety. J Am Acad Dermatol 2001 Jan; 44 (1 Suppl.): S39–46
39.
Fleischer Jr AB, Ling M, Eichenfield L, et al. Tacrolimus ointment for the treatment of atopic dermatitis is not associated with an increase in cutaneous infections. J Am Acad Dermatol 2002 Oct; 47 (4): 562–70PubMedCrossRef
40.
Protopic package insert. Deerfield (IL): Fujisawa Healthcare, Inc., 2000
41.
Elidel package insert. East Hanover (NJ): Novartis Pharmaceuticals, 2003
42.
Alaiti S, Kang S, Fiedler VC, et al. Tacrolimus (FK506 ointment for atopic dermatitis: a phase I study in adults and children. J Am Acad Dermatol 1998 Jan; 38 (1): 69–76PubMedCrossRef
43.
Schnopp C, Remling R, Möhrenschlager M, et al. Topical tacrolimus (FK506 and mometasone furoate in treatment of dyshidrotic palmar eczema: a randomized, observer-blinded trial. J Am Acad Dermatol 2002 Jan; 46 (1): 73–7PubMedCrossRef
44.
Kempers S, Boguniewicz M, Carter E, et al. A randomized investigator-blinded study comparing pimecrolimus cream 1 % with tacrolimus ointment 0.03% in the treatment of pediatric patients with moderate atopic dermatitis. J Am Acad Dermatol 2004 Oct; 51 (4): 515–25PubMedCrossRef
45.
Paller AS, Lebwohl M, Fleischer Jr AB, et al. Tacrolimus ointment is more effective that pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: results from 3 randomized, comparative studies. J Am Acad Dermatol 2005 May; 52 (5): 810–22PubMedCrossRef
46.
Fleischer AB. Controlling atopic dermatitis with Protopic: new insights. Oral presentation at the 12th Congress of the European Academy of Dermatology and Venereology; 2003 Oct 15–18; Barcelona, Spain
47.
Lapidus CS. Role of social factors in atopic dermatitis: the US perspective. J Am Acad Dermatol 2001 Jul; 45 (1 Suppl.): S41–3PubMedCrossRef
48.
49.
Lapidus CS, Schwas DF, Honig PJ. Atopic dermatitis in children: who cares? Who pays? J Am Acad Dermatol 1993; 28 (5 Pt 1): 699–703PubMedCrossRef
50.
Sander HM, Morris LF, Phillips CM, et al. The annual cost of psoriasis. J Am Acad Dermatol 1993 Mar; 28 (3): 422–5PubMedCrossRef
51.
Ward MM, Javitz HS, Smith WM, et al. Direct medical cost of chronic obstructive pulmonary disease in the USA. Respir Med 2000 Nov; 94 (11): 1123–9PubMedCrossRef
52.
Begley CE, Famulari M, Annegers IF, et al. The cost of epilepsy in the United States: an estimate from population-based clinical and survey data. Epilepsia 2000 Mar; 41 (3): 342–51PubMedCrossRef
53.
Emerson RM, Williams HC, Allen BR. What is the cost of atopic dermatitis in preschool children? Br J Dermatol 2001; 144 (3): 514–22PubMedCrossRef
54.
55.
Gieler U, Hohmann M, Niemeier V, et al. Cost evaluation in atopic eczema. J Dermatol Treat 1999; 10: S15–20
56.
Su JC, Kemp AS, Varigos GA, et al. Atopic eczema: its impact on the family and financial cost. Arch Dis Child 1997; 76 (2): 159–62PubMedCrossRef
57.
Fivenson D, Arnold RJ, Kaniecki DJ, et al. The effect of atopic dermatitis on total burden of illness and QOL on adults and children in a large managed care organization. J Manag Care Pharm 2002; 8 (5): 333–41PubMed
58.
59.
Daud LR, Garralda ME, David TJ. Psychosocial adjustment in preschool children with atopic eczema. Arch Dis Child 1993 Dec; 69 (6: 670–6PubMedCrossRef
60.
Lapidus CS, Kerr PE. Social impact of atopic dermatitis. Med Health R I 2001 Sep; 84 (9): 294–5PubMed
61.
Dahl RE, Bernhisel-Broadbent J, Scanlon-Holdford S, et al. Sleep disturbance in children with atopic dermatitis. Arch Pediatr Adolesc Med 1994 Aug; 149 (8): 856–60CrossRef
62.
Drake L, Prendergast M, Maher R, et al. The impact of tacrolimus ointment on health-related QOL of adult and pediatric patients with atopic dermatitis. J Am Acad Dermatol 2001 Jan; 44 (1 Suppl.): S65–72PubMedCrossRef
63.
Finlay AY. Measures of the effect of adult severe atopic eczema on QOL. J Fur Acad Dermatol Venereol 1996 Sep; 7 (2): 14954
64.
Linnet J, Jemec GB. An assessment of anxiety and dermatology life quality in patients with atopic dermatitis. Br J Dermatol 1999 Feb; 140 (2): 268–72PubMedCrossRef
65.
Reid P, Lewis-Jones MS. Sleep difficulties and their management in preschoolers with atopic eczema. Clin Exp Dermatol 1995 Jan; 20 (1): 38–41PubMedCrossRef
66.
Schiffner R, Schiffner-Rohe J, Landthaler M, et al. Treatment of atopic dermatitis and impact on QOL: a review with emphasis on topical non-corticosteroids. Pharmacoeconomics 2003; 21 (3): 159–79PubMedCrossRef
67.
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): a simple practical measure for routine clinical use. Clin Exp Dermatol 1994 May; 19 (3): 210–6PubMedCrossRef
68.
Lewis-Jones MS, Finlay AY. The Children’s Dermatology Life Quality Index (CDLQI): initial validation and practical use. Br J Dermatol 1995 Jun; 132 (6): 942–9PubMedCrossRef
69.
Whalley D, Huels J, McKenna SP, et al. The benefit of pimecrolimus (Elidel, SDZ ASM 981) on parents’ QOL in the treatment of pediatric atopic dermatitis. Pediatrics 2002 Dec; 110 (6: 1133–6PubMedCrossRef
70.
Whalley D, McKenna SP, Dewar AL, et al. International development of a measure to assess QOL in childhood atopic dermatitis — the PIQoL-AD. Qual Life Res 2000; 9: 302
71.
Whalley D, McKenna S, Huels J, et al. Pimecrolimus (SDZ ASM 981) in the treatment of paediatric atopic eczema: benefit to QOL and health related QOL [abstract P0284]. 20th World Congress of Dermatology Conference; 2002 Jul 1–5; Paris
72.
Whalley D, McKenna S, Huels J, et al. Pimecrolimus (SDZ ASM 981) in the treatment of atopic eczema: benefit to QOL among infants [abstract P0283]. 20th World Congress of Dermatology Conference; 2002 Jul 1–5; Paris
73.
Ellis CN, Reiter KL, Wheeler JR, et al. Economic analysis in dermatology. J Am Acad Dermatol 2002 Feb; 46 (2): 271–83PubMedCrossRef
74.
Lundberg L, Johannesson M, Silverdahl M, et al. QOL, healthstate utilities and willingness to pay in patients with psoriasis and atopic eczema. Br J Dermatol 1999; 141: 1067–79: e28PubMedCrossRef
75.
Friedman JY, Reed SD, Weinfurt KP, et al. Parents’ perception of the QOL impact of childhood atopic dermatitis disease states [abstract]. American Academy of Dermatology Conference; 2003 Mar 21–26; San Francisco. 19
76.
Ellis C, Drake L, Prendergast M, et al. Cost-effectiveness analysis of tacrolimus ointment versus high-potency topical corticosteroids in adults with moderate-to-severe atopic dermatitis. J Am Acad Dermatol 2003 Apr; 48 (4): 553–63PubMedCrossRef
77.
Ellis CN, Kahler K, Grueger J. Long-term management of atopic dermatitis with pimecrolimus cream I%: an economic analysis [abstract]. American Academy of Dermatology Conference; 2003 Mar 21–26; San Francisco. P205
78.
Verboom P, Hakkaart-van Roijen L, Rutten F, et al. The cost effectiveness of pimecrolimus (SDZ ASM 981) topical cream 1% and corticosteroids in the treatment of atopic dermatitis [abstract]. American Academy of Dermatology Conference; 2003 Mar 21–26; San Francisco. 279
79.
Abramovits W, Boguniewicz M, Prendergast MM, et al. Comparisons of efficacy and cost effectiveness of topical immunomodulators in the management of atopic dermatitis. J Med Econ 2003; 6: 1–14CrossRef
80.
Hanifin JM, Thurston M, Omoto M, et al. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol 2001 Feb; 10 (1): 11–8PubMedCrossRef
81.
Arikian SR, Einarson TR, Doyle JJ. Economic evaluation of treatments for eczema and atopic dermatitis. In: Rajagopalan R, Sherertz EF, Anderson RT, editors. Care management of skin diseases: life quality and economic impact. New York: Marcel Dekker, 1998: 317–40
82.
Lamb SR, Rademaker M. Pharmacoeconomics of drug therapy for atopic dermatitis. Expert Opin Pharmacother 2002 Mar; 3 (3): 249–55PubMedCrossRef
83.
Williams H. Another vehicle-controlled study of 1% pimecrolimus in atopic dermatitis: how does it help clinicians and patients, and is it ethically sound? Arch Dermatol 2002 Dec; 138 (12): 1602–3PubMedCrossRef
Metadata
Title
The economics of topical immunomodulators for the treatment of atopic dermatitis
Authors
William Abramovits
Mark Boguniewicz
Amy S. Paller
Diane L. Whitaker-Worth
Mary M. Prendergast
Michael Tokar
Kuo B. Tong
Publication date
01-06-2005
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 6/2005
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200523060-00003

Other articles of this Issue 6/2005

PharmacoEconomics 6/2005 Go to the issue

Commentary

Health utilities in Alzheimer’s disease and implications for cost-effectiveness analysis

Leading Article

Incorporation of uncertainty in health economic modelling studies

Original Research Article

The cost effectiveness of infliximab for severe treatment-resistant rheumatoid arthritis in the UK

Original Research Article

Development of an economic model to assess the cost effectiveness of treatment interventions for chronic obstructive pulmonary disease

Review Article

Bipolar disorder and health-related quality of life

Review Article

Pharmacoeconomic evaluation of antidepressants