Home Narrowband Ultraviolet B Phototherapy for Photoresponsive Skin Conditions: A Health Technology Assessment.
Level 1 - systematic review of randomized trials
Systematic review of randomized controlled trials (single RCT identified)
What was done
This health technology assessment evaluated the clinical effectiveness, safety, cost-utility, budget impact, and patient preferences regarding home versus outpatient clinic narrowband ultraviolet B (NB-UVB) phototherapy for photoresponsive skin conditions. Clinical evidence was gathered via a systematic review assessed using the Cochrane RoB 2 tool and GRADE criteria. Economic modeling included a 10-year cost-utility analysis from a public payer perspective in psoriasis, a 5-year budget impact analysis in Ontario, and direct patient interviews.
What was found
The clinical review identified 1 randomized controlled trial in mild-to-severe psoriasis. Baseline PASI 50 improvement was observed in 82% of home-treated versus 79% of clinic-treated participants (mean difference 2.8%, 95% CI -8.6% to 14.2%), exceeding the -15% noninferiority margin (GRADE: Moderate). Adverse events (erythema, burning, blistering) occurred in both groups but were too infrequent to assess comparative safety (GRADE: Low). Home NB-UVB had an incremental cost of $4,509 and an incremental QALY gain of 0.29, yielding an ICER of $15,675 per QALY gained (77% probability of being cost-effective at $50,000/QALY). The 5-year net budget impact was $3.3 million for psoriasis and $6.3 million for all photoresponsive skin conditions.
Why it matters
Home NB-UVB phototherapy provides a clinically noninferior and cost-effective treatment option for psoriasis, offering an accessible alternative for patients facing geographical, physical, or scheduling barriers to in-clinic care.
Limits
Clinical evidence was limited to a single trial investigating only psoriasis, providing no direct trial evidence for other photoresponsive skin conditions. Adverse event numbers were too low to permit comparative safety conclusions. The broader budget impact model for non-psoriasis conditions excluded disease-specific non-phototherapy medical costs. Total participant count was not reported in the abstract.
Cited by
- supports UVB phototherapy has been demonstrated to effectively treat and clear psoriasis.