Cost of Eczema Care
Eczema costs families money directly (creams, co-pays, special bedding, transport) and indirectly (time off work, childcare, lost sleep). It also costs health systems. How much falls on the family depends on where they live. In the UK, NHS prescriptions are free for children under 16, so prescribed Emollient Therapy, Topical Corticosteroids and Topical Calcineurin Inhibitors cost the family nothing at the pharmacy. Over-the-counter (OTC) products, “natural” remedies and household changes are still paid out of pocket. In the US, even prescribed care involves deductibles, co-pays and uncovered items, and moisturisers, the foundation of treatment, are usually not reimbursed. Costs rise with severity in every study below. Good control is therefore also the cheapest outcome for families.
Cost of Eczema Care [relates] Atopic Dermatitis Cost of Eczema Care [relates] Treatment Outcomes Comparison Emollient Therapy [part-of] Cost of Eczema Care
Unit prices of the main treatments
| Item | UK (NHS price, paid by NHS for under-16s) | US (cash price, indicative) | Source |
|---|---|---|---|
| Leave-on emollients | ”Cost-effective” list: under £1.15 per 100 g/ml, e.g. 500 g tubs £2.49–£5.64 | Paid OOP by 98.6% of US caregivers; about 1 in 5 spend >$100/month | PrescQIPP B76 (2015); Chovatiya 2023 |
| Hydrocortisone 1% (mild TCS) | Among the cheapest mild TCS; 2.5% is 18–58× dearer per gram; OTC packs smaller and dearer than prescription packs | OTC ≤1% (not for under-2s without a clinician) | PrescQIPP 307 (2022) |
| Clobetasone Butyrate 0.05% (moderate TCS) | ~10× the cost per gram of the cheapest moderate TCS (betamethasone valerate 0.025%) | — | PrescQIPP 307 |
| Tacrolimus 0.03% ointment | Protopic 30 g: £23.33 (NHS indicative price since Nov 2016) | Generic 60 g: average $133 (GoodRx guide); coupon from ~$20; prior authorisation needed for ~50% of Medicaid enrollees | NHS dm+d; GoodRx |
| Pimecrolimus 1% cream | Not retrieved | 30 g retail ~$195–212; coupon ~$70–82 | GoodRx; Rx.com |
| Crisaborole 2% ointment | — | 60 g ~$1,035 average (coupon ~$710) | SingleCare |
| Dupilumab | £1,264.89 per 2 pre-filled syringes (BNF 2018 list price); hospital-only | Not retrieved this round | BNF via Dupilumab note |
PrescQIPP [regulates] Emollient Therapy PrescQIPP [regulates] Topical Corticosteroids Hydrocortisone [part-of] Topical Corticosteroids
Conflict: [GoodRx, “How much is tacrolimus without insurance”, n.d.] gives the average cash price of a 60 g tube of generic tacrolimus 0.03% as $133.12. [GoodRx tacrolimus price page, Sept 2025] gives the “average retail price” of the same pack as $516.66. The two pages probably use different reference prices, but a parent would not know which figure to expect. Unresolved — add to open_questions.
The BEE Trial found no clinical difference between lotions, creams, gels and ointments. Cochrane 2017 found “no reliable evidence that one moisturiser is better than another”. Together these support the NHS policy of prescribing the cheapest emollient a child will actually use. NHS England spent £8.6 million a year on urea emollients in 2014–15, which PrescQIPP says should be reserved for specific groups (see Urea Creams). The relative prices show why toddlers are usually prescribed hydrocortisone 1% and not branded or 2.5% versions.
BEE Trial [supports] Emollient Therapy Urea Creams [part-of] Emollient Therapy
What families spend
| Study | Setting / population | Key cost findings |
|---|---|---|
| Emerson, Williams & Allen, Br J Dermatol 2001 | Nottingham, UK; children aged 1–5 (1995–96) | Total £79.59 per child per year: NHS consultations £28.62, prescriptions £22.03 (76% emollients and bath products), family costs £28.94 (36%: home changes, OTC medicines, transport, homoeopath visits, lost salary). UK total for ages 1–5: £47 m/yr |
| Su et al., Arch Dis Child 1997 | Australian clinic, 48 children | Annual personal cost Aus$330 (mild), $818 (moderate), $1,255 (severe). Family impact of moderate/severe eczema exceeded that of type 1 diabetes |
| Filanovsky et al., J Pediatr 2016 | Cleveland, US; 82 caretakers of children 6 mo–12 y, moderate-to-severe | Mean $274/month (median $114): $75 direct, $199 indirect. On average 34.8% of available monthly money went on AD care |
| Smith Begolka et al., Dermatitis 2021 | US NEA survey, 1,118 patients/caregivers | Median $600/yr; 41.9% ≥$1,000. OOP for moisturisers 94.3%, supplements 52.2%, alternative medications 19.0%, adjunctive therapies 15.9%, prescriptions not covered 48.6% |
| Chovatiya et al., Skin Health Dis 2023 | Same survey, 228 caregivers of under-18s | Median $860/yr vs $500 for adults; 48.9% ≥$1,000. Higher OOP for emollients, bathing products, childcare, cleaning products, clothing/bedding. 69.5% reported moderate, severe or devastating household financial impact. ≥$1,000/yr predicted harmful impact (aOR 6.98) |
National Eczema Association [relates] Cost of Eczema Care Atopic Dermatitis [causes] Cost of Eczema Care
Conflict: [Emerson et al., Br J Dermatol 2001] found family costs were about a third (36%) of total AD costs for UK preschoolers, with NHS consultations and prescriptions making up the rest. [Filanovsky et al., J Pediatr 2016] found indirect costs (mainly lost work time) made up most of US families’ monthly spend ($199 of $274 mean). The settings differ (UK population sample of mostly mild disease vs US clinic sample of moderate-to-severe), so the share of cost borne by families is not settled. Unresolved — add to open_questions.
Spending on Track A remedies
No study located gives a figure for what families spend on home or herbal remedies for a toddler. The available signals are indirect. In Nottingham, homoeopath visits were counted in family costs (Emerson 2001). In the US NEA survey, 19.0% of households paid out of pocket for “alternative medications” and 52.2% for dietary supplements (Smith Begolka 2021). Cochrane reviews show that the commonest supplements (evening primrose oil, probiotics) do not work for eczema. In the Leicester clinic, 46% of children had used complementary medicine, most often Chinese Herbal Medicine (Johnston 2003). That study reported use and perceived benefit, not cost. Because Track A products are never reimbursed, and UK prescriptions for children are free, a UK family choosing Track A pays more for treatments with less evidence. See Treatment Outcomes Comparison and Herbal and Home Remedies for Eczema.
Herbal and Home Remedies for Eczema [relates] Cost of Eczema Care Evening Primrose Oil [relates] Cost of Eczema Care Probiotics [relates] Cost of Eczema Care
Connections
- Treatment Outcomes Comparison — cost row of the Track A vs B comparison, source: this note
- Emollient Therapy — largest NHS prescribing cost; largest US OOP item, source: Emerson 2001; Chovatiya 2023
- Hydrocortisone — 1% low-cost, 2.5% 18–58× dearer, source: PrescQIPP 307
- Clobetasone Butyrate — ~10× cheapest moderate TCS, source: PrescQIPP 307
- Tacrolimus — £23.33/30 g NHS; ~$133/60 g US cash, source: NHS dm+d; GoodRx
- Pimecrolimus — ~$195–212 retail per 30 g, source: GoodRx; Rx.com
- Crisaborole — ~$1,035 per 60 g, source: SingleCare
- Dupilumab — £1,264.89 per 2 syringes, source: BNF 2018
- Topical Corticosteroids — cost-effective choice by potency, source: PrescQIPP 307
- Topical Calcineurin Inhibitors — price and prior-authorisation barrier, source: GoodRx
- Urea Creams — £8.6 m/yr NHS spend, source: PrescQIPP B76
- BEE Trial — no emollient type better, so cheapest acceptable is fine, source: Ridd 2022
- Herbal and Home Remedies for Eczema — CAM spending signals, source: Smith Begolka 2021; Johnston 2003
- Chinese Herbal Medicine — most-used CAM in Leicester, source: Johnston 2003
- National Eczema Association — ran the US OOP survey, source: Smith Begolka 2021
- PrescQIPP — NHS cost-effectiveness bulletins, source: PrescQIPP 307, B76
- Atopic Dermatitis — disease cost driver, source: Emerson 2001
- CLOTHES Trial — silk garments £56,811/QALY, not cost-effective, source: Thomas, PLoS Med 2017