Abstract
BackgroundOne in five children visiting a homeopathic physician suffers from atopic eczema.ObjectivesWe aimed to examine the long-term effectiveness, safety and costs of homoeopathic vs. conventional treatment in usual medical care of children with atopic eczema.MethodsIn this prospective multi-centre comparative observational non-randomized rater-blinded study, 135 children (48 homoeopathy, 87 conventional) with mild to moderate atopic eczema were included by their respective physicians. Depending on the specialisation of the physician, the primary treatment was either standard conventional treatment or individualized homeopathy as delivered in routine medical care. The main outcome was the SCORAD (SCORing Atopic Dermatitis) at 36 months by a blinded rater. Further outcomes included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months after baseline. A multilevel ANCOVA was used, with physician as random effect and the following fixed effects: age, gender, baseline value, severity score, social class and parents’ expectation.ResultsThe adjusted mean SCORAD showed no significant differences between the groups at 36 months (13.7 95% CI [7.9–19.5] vs. 14.9 [10.4–19.4], p = 0.741). The SCORAD response rates at 36 months were similar in both groups (33% response: homoeopathic 63.9% vs. conventional 64.5%, p = 0.94; 50% response: 52.0% vs. 52.3%, p = 0.974). Total costs were higher in the homoeopathic versus the conventional group (months 31–36 200.54 Euro [132.33–268.76] vs. 68.86 Euro [9.13–128.58], p = 0.005).ConclusionsTaking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs.
Highlights
Comparative Effectiveness Research (CER) is a growing field in health care research; it has considerable potential to inform stakeholders on decision-making
Taking patient preferences into account, while being unable to rule out residual confounding, in this longterm observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs
Population 135 children were included into the study and analyzed in the primary analysis after 6 months (mean age 4.0162.97 (SD), 48% girls, conventional group n = 87, homeopathic group n = 48, Table 1)
Summary
Comparative Effectiveness Research (CER) is a growing field in health care research; it has considerable potential to inform stakeholders on decision-making. In this paper we use the working definition as established by the Institute of Medicine (IOM) Committee, which defines CER as ‘‘the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care’’. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels [1]. Atopic eczema is a chronic inflammatory skin disease associated with pruritus, which occurs predominantly in children [3,4]. One in five children visiting a homeopathic physician suffers from atopic eczema
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