Cost-effectiveness of oral alitretinoin in patients with severe chronic hand eczema - a long-term analysis from a Swiss perspective

A long-term Markov cohort simulation model was used to estimate direct medical costs (€) and clinical effectiveness (quality adjusted life years, QALYs) of treating severe CHE patients with alitretinoin. Comparison was against the standard treatment of supportive care (optimised emollient therapy). Information on response rates were derived from a randomized controlled clinical trial. Costs were considered from the perspective of the Swiss health system. Swiss epidemiological data was derived from official Swiss Statistic institutions.Annual costs of alitretinoin treatment accounted for €2'212. After a time horizon of 22.4 years, average remaining long-term costs accounted for €42'208 or €38'795 in the alitretinoin and the standard treatment arm, respectively. Compared with the standard therapy, the addition of alitretinoin yielded an average gain of 0.230 QALYs at the end of the simulation. Accordingly, the incremental cost-effectiveness ratio resulted in €14'816/QALY gained. These results were robust to changes in key model assumptions.The therapy for CHE patients is currently insufficient. In our long-term model we identified the treatment with alitretinoin as a cost-effective alternative for the therapy of CHE patients in Switzerland.Hand eczema is a widespread dermatological condition associated with a chronic course and poor healing rates [1]. Particularly in severe patients, the response to the treatment is commonly very bad. Despite the currently available therapies, the illness leads frequently to a chronic course [1,2]. It is well known that patient's quality of life is affected negatively by restricted function of the hands, severe psychological strain and also economical implications [3-5].The prevalence of patients with hand eczema is estimated at 7% to 12% in the general population [5,6]. However, the fraction of severe chronic hand eczema (CHE) among hand eczema patients is assumed to be 5-7%, whereas 2-4% are estimated to be refractory to topical ste