JMIR Publications

ABSTRACT

Chronic inflammatory skin diseases such as psoriasis, eczema and chronic urticaria impose substantial psychosocial burden despite their low mortality risk. This disease burden is strongly influenced by psychobehavioural factors which are often unaddressed in clinical dermatological practice. MindMySkin is a self-administered digital psychobehavioural intervention developed to reduce symptom burden and improve health-related quality of life. This protocol describes an economic evaluation conducted alongside a randomised controlled trial to determine the cost-effectiveness of MindMySkin within Singapore’s healthcare system. A double-blind randomised controlled trial will recruit English-speaking participants aged 16 years and above with psoriasis, eczema or chronic urticaria across three sites in Singapore. Participants will be randomised 2:1 to MindMySkin or an active digital control and followed for 32 weeks. Costs include intervention deployment and dermatology-related healthcare utilisation for an analysis conducted from the primary healthcare system perspective, and adds indirect medical costs and work productivity losses for a sensitivity analysis conducted from the societal perspective. Health outcomes include changes in Dermatology Life Quality Index scores and quality-adjusted life years derived from the EuroQol five-dimension five-level instrument. Incremental cost-effectiveness ratios and net monetary benefit will be estimated using intention-to-treat analyses with regression adjustment. Uncertainty will be explored using bootstrapping, deterministic sensitivity analyses, subgroup analyses and scenario modelling. A Markov model-based extrapolation over five years will be undertaken if within-trial results suggest cost-effectiveness. Digital mental health interventions are increasingly deployed but few undergo the needed economic evaluation for cost-effectiveness. By embedding a health economic evaluation within a randomised controlled design and incorporating condition-sensitive outcome measures, this study advances methodological standards for evaluating scalable psychobehavioural interventions. Demonstrating value through disability reduction rather than survival gain may strengthen the legitimacy of low-intensity digital therapeutics within health technology assessment frameworks and inform implementation decisions in resource-constrained health systems.