An economic evaluation of the randomised controlled trial of topical corticosteroid and home-based narrowband UVB for active and limited vitiligo (The HI-Light Trial).

BACKGROUND Economic evidence for vitiligo treatments is absent. OBJECTIVE To determine the cost-effectiveness of (a) hand-held narrowband-UVB (NB-UVB) and (b) combination of topical corticosteroid (TCS) and NB-UVB compared to TCS for localised vitiligo. METHODS Cost-effectiveness analysis alongside a pragmatic, 3-arm, placebo-controlled RCT with 9 months' treatment. 517 Adults and children (aged ≥5 years) with active vitiligo affecting <10% of skin recruited from secondary care and community were randomised 1:1:1 to receive: TCS; NB-UVB; or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured QALYs using the EQ-5D-5L for those aged 11+ and CHU-9D for those aged 5 to <18. RESULTS Mean (SD) cost per participant was £774.4 (83.71) for NB-UVB, £813.38 (111.39) for combination treatment and £599.98 (96.18) for TCS. In analyses adjusted for age and target patch location, incremental difference in cost for combination treatment compared to TCS was £211.46 (95% CI 188.10 to 234.81), corresponding to a risk difference of 10.94% (Number-Needed-To-Treat (NNT= 9). Incremental cost was £1,932.35 per successful treatment. The incremental difference in cost for NB-UVB compared to TCS was £173.44 (95% CI 150.55 to 196.32) with a risk difference of 5.20% (NNT=19). Incremental cost was £3,335.74 per successful treatment. CONCLUSION Combination treatment, compared to TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost effective if decision makers are willing to pay £1,932 per additional treatment success.